Language For Those Who Have Nothing - Mikhail Bakhtin and the Landscape of Psychiatry (Cognition and Language: A Series in Psycholinguistics)

Language for Those Who Have Nothing Mikhail Bakhtin and the Landscape of Psychiatry

COGNITION AND LANGUAGE A Series in Psycholinguistics Series Editor: R. W. RIEBER Recent Volumes in this Series:

AMERICAN AND CHINESE PERCEPTIONS AND BELIEF SYSTEMS: A People’s Republic of China-Taiwanese Comparison Lorand B. Szalay, Jean B. Strohl, Liu Fu, and Pen-Shui Lao THE COLLECTED WORKS OF L. S. VYGOTSKY Volume 1: Problems of General Psychology Volume 2: The Fundamentals of Defectology (Abnormal Psychology and Learning Disabilities) Volume 3: Problems of the Theory and History of Psychology Volume 4: The History of the Development of Higher Mental Functions Volume 5: Child Psychology Volume 6: Scientific Legacy EXPERIMENTAL SLIPS AND HUMAN ERROR: Exploring the Architecture of Volition Edited by Bernard J. Baars LANGUAGE FOR THOSE WHO HAVE NOTHING Mikhail Bakhtin and the Landscape of Psychiatry Peter Good LANGUAGE, THOUGHT, AND THE BRAIN Tatyana B. Glezerman and Victoria I. Balkoski PSYCHOENVIRONMENTAL FORCES IN SUBSTANCE ABUSE PREVENTION Lorand B. Szalay, Jean Bryson Strohl, and Kathleen T. Doherty THE PSYCHOPATHOLOGY OF LANGUAGE AND COGNITION Robert W. Rieber and Harold J. Vetter TIME, WILL, AND MENTAL PROCESS Jason W. Brown VYGOTSKY’S PSYCHOLOGY-PHILOSOPHY: A Metaphor for Language Theory and Learning Dorothy Robbins A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

Language for Those Who Have Nothing Mikhail Bakhtin and the Landscape of Psychiatry Peter Good

Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow

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Abbreviations

AA

Mikhail Bakhtin, ‘Art and Answerability’, in Art and Answerability: Early Philosophica Essays by M. M. Bakhtin, trans. Liapunov V. and Brostrom K., ed. Michael Holquist, Austin, University of Texas Press, 1990.

AH

Mikhail Bakhtin, ‘Author and Hero in Aesthetic Activity’, in Art and Answerability: Early Philosophical Essays by M. M. Bakhtin, trans. Liapunov V. and Brostrom K., ed. Michael Holquist, Austin, University of Texas Press, 1990.

CMF

Mikhail Bakhtin, ‘The Problem of Content, Material and Form in Verbal Artistic Creation’, in Art and Answerability: Early Philosophical Essays by M.M. Bakhtin, trans. Liapunov V. and Brostrom K., ed. Michael Holquist, Austin, University of Texas Press, 1990.

DiN

Mikhail Bakhtin, ‘Discourse in the Novel’, in The Dialogic Imagination: Four Essays by M. M. Bakhtin, trans. Caryl Emerson and Michael Holquist, ed. Michael Holquist, Austin, University of Texas Press, 198 1.

EN

Mikhail Bakhtin, ‘Epic and Novel’, in The Dialogic Imagination: Four Essays by M. M. Bakhtin, trans. Caryl Emerson and Michael Holquist, ed. Michael Holquist, Austin, University of Texas Press, 1981.

FM

P. M. Medvedev, The Formal Method in Literary Scholarship, trans. Wehrle A. J., Cambridge, MA., Harvard University Press, 1985.

FR

V. N. Volosinov, Freudianism: A Marxist Critique, trans. Titunik, I.R.,

New York, Academic Press, 1976. vii

viii

Abbreviations

FTC

Mikhail Bakhtin, ‘Forms of Time and of the Chronotope in the Novel’, in The Dialogic Imagination: Four Essays by M. M. Bakhtin, trans. Caryl Emerson and Michael Holquist, Austin, University of Texas Press, 198 1.

MPL

V. N. Volosinov, Marxism and the Philosophy of Language, trans. Matejka L. and Titunik I.R., Cambridge, MA., Harvard University Press, 1986.

PDP

Mikhail Bakhtin, Problems of Dostoevsky's Poetics, trans. and ed. by Caryl Emerson, Minneapolis, University of Minnesota Press, 1984.

PND

Mikhail Bakhtin, ‘From the Prehistory of Novelistic Discourse’, in The Dialogic Inzagination: Four Essays by M. M. Bakhtin, trans. Caryl Emerson and Michael Holquist, ed. Michael Holquist, Austin, University of Texas Press, 1981.

RAHW Mikhail Bakhtin, Rabelais and His World, trans. Iswolsky H., Bloomington, IN., Indiana University Press, 1984.

SG

Mikhail Bakhtin, Speech Genres and Other Late Essays, trans. McGee V., ed. Caryl Emerson and Michael Holquist, Austin, University of Texas Press, 1986.

TPA

Mikhail Bakhtin, Toward a Philosophy of the Act, trans. Liapunov, V., eds. Michael Holquist and Vadim Liapunov, Austin, University of Texas Press, 1993.

TRDB Mikhail Bakhtin, ‘Towards a Reworking of the Dostoevsky book’, Appendix 11 in Problems of Dostoevsky's Poetics, trans. and ed. by Caryl Emerson, Minneapolis, University of Minnesota Press, 1984.

Preface

For Mikhail Bakhtin, language is the social dynamic occupying the space between separate consciousnesses. There can be no ‘neutral’ words. Language is everywhere inlaid with intentions and accents. To gain meaning, words must first be infused with life by being expressed through a living consciousness. Once expressed they must then struggle for recognition in the social space shared by other living words. Every utterance becomes an expression of meaning given through a living body. And because every utterance is social it is invested by the anticipation of the other’s response. And herein lies the basis of Bakhtin’s concept of Dialogue. For him, every single utterance, whether a thought, a written text, or a simple everyday salutation is a voice addressed to another. Through this intimate social connection the utterance belongs not only to the speaker but to the interlocutor as well. By combining addressivity and anticipation both speakers come to take on a shared responsibility for meaning. A mutual sense of meaning is created in the space formed by two separate consciousnesses. Understood this way, language becomes a series of unrepeatable social encounters. Each utterance is made unique by the measure of its own social space. No single utterance can ever be repeated because the social conditions of every interaction change from moment to moment. Such is the complexity of human dialogue. Its complexity is evident when we consider that all bodies are able to call upon a wide range of voices that are judged to be appropriate to a particular social encounter. Accordingly, voices because they are living social forces - are stratified across the full social spectrum. From the way a voice is employed it is relatively easy to determine how it gives standing to a body on a landscape. Those voices that cluster around the central and the more powerful regions come to assume the ix

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Language For Those Who Have Nothing

mantle of the official voice and are the focus by which other voices are measured against. History suggests that when one voice presides over this central zone, the less it is willing to consider the response of other voices, Higher languages, it will be seen, are given to discussion only within the orbit of their own guarded registers even though other voices could be more adequate to the task. I confess I have long been frustrated with the nature of dialogue in psychiatry. I have been suspicious of the powerful rhythms that run through psychiatry’s official utterances. I have felt that this is a voice addressed more to shoring up its own standing rather than expressing a willingness to engage with its own multi-levelled landscape of voices. My vision of psychiatry has been one of a landscape dotted with various sites of official voices in constant competition for an ever-elusive security of standing. Different professions and historically determined tiers of hierarchies joust with one another for the ownership of mental illness. Committed to this struggle, these professional voices make strenuous efforts to mimic the same rhythms of the official voice in order to gain recognition. From Bakhtin, I was made to realise that both the questions and the answers asked in psychiatry belong to the same voice. There is scant evidence to suggest any open dialogue between official and unofficial voices. Yet, wherever I wandered on the wards or in the canteens, the voices of humour, of unofficial terminology, of parody, and of folk belief appeared to be thriving. I believe that many of these voices describe a reality that official voices cannot always explain. Jokes voice a constant commentary on the relationship between practitioners and patients. Unofficial utterances speak of throwing a wobbly or of someone being high. Yet these are voices that are accurately descriptive of mental states and are immediately understood by everyone. Bakhtin is insistent that official and unofficial languages are interdependent upon each other. One voice cannot exist alone because all voices possess form-shaping qualities upon the other. Thus, a central premise runs through this book: In every region of the psychiatric landscape, official ends are being met by unofficial means. The gaps in official knowledge, and there are many, are being filled-in with unofficial voices. Psychiatry is actively dependent upon unofficial meanings to an extent that it is unwilling to concede. This book draws heavily upon Bakhtin’s sense of polyphony in order to devise a means of navigation. I will argue that to engage with the voices that play on this landscape requires more than a simple intellectual shift. So often, practitioners find themselves entering the clinic on a purely intellectual level. Polyphony demands a physical change to one’s own bodily standing. Words sometimes need different bodies in order to live and

Preface

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breathe. To travel polyphonically means that the traveller must be prepared to engage their own body in a dialogue. My initial attraction to Mikhail Bakhtin began when I learned that he was only one of a very few independent thinkers who survived the atrocities of the Soviet experiment. Many lesser minds than his were simply put up against a wall and shot. True, he did suffer a period of exile, but I was intrigued to discover what qualities Bakhtin possessed that were sufficient to ensure he reached his eightieth year. I was to find that a combination of passion and humility enabled him to conduct a specific form of dialogue with others. Yet, added to these otherwise admirable qualities, came the knowledge of his capacity for deception. Current Bakhtinian scholarship is increasingly uncovering a trail of untruths and imitations in his methodology. These are grave charges in the Western Canon. But it is too easy for the cut and thrust of liberal criticism to forget that Bakhtin wrote his manuscripts – on borrowed exercise books and scraps of paper – at a time when an ominous knock on the door was an ever-present reality. Bakhtin’s work on the Carnival suggests that other levels of meaning are in constant attendance on the official voice. Expressed in bodily terms, the high voice of the head is always complimented by the different realities of the lower bodily strata. However much the bodies of higher social standing tries to reject this interdependence, the lower voice will always manage to make its presence known. As a polyphonic traveller I have used the carnival practice of taking the high down into the low before returning to a previous, albeit replenished, standing. Across several regions of psychiatry I have employed the carnival forces of masks and deceptions in order to discover the range of voices available. My book begins in the higher voices of the head and then commences on a series of embodied step-downs. Before I made this journey I had always considered myself an egalitarian and compassionate practitioner, one who was firmly placed on the radical edge of psychiatry. What I was to discover changed fundamentally my views on psychiatry. Thanks are offered to the Bakhtinian scholar, Dr Mikael Leiman, and to Father John of the Valamo monastery. Among those who have left powerful impressions on my work are Colin Brady, Dr Peter Speedwell, and Professor Alec Jenner. Inducement and support has come in different ways from the poet, Dave Cunliffe, and the artist, Arthur Moyse. Thanks are also offered to Kit Good, an embryonic Don, to whom this book is dedicated, and finally to Caroline, who actually chooses to live with me. Much of the time spent researching this book belonged to her. I am grateful for all these gifts. Peter Good West Yorkshire, May 2000.

Contents 1

Introduction Preamble Bakhtin The Material Bodily Sphere What Potential is Offered to the Traveller by this Realism? The Official Landscape of Psychiatry Bakhtin and the Psychiatric Landscape

1 2

6 8 10 15

Chapter One

21

The Chronotope The Care Chronotope The Patient Chronotope Whose Time is it and to Whom does it Belong? Imposed Time

23 27 28 29

Chapter Two

I Need to Know Where I Stand? The Official Languages of the Care Chronotope

33 36

The Official Voice

Chapter Three

The Ringmaster and Laughter in the Care Chronotope

47 48 49 51

Polyphony Anecdotes Method xiii

Language for Those Who Have Nothing

xiv

Status Response Targets Humour and Laughter -The Student Cluster Humour and Laughter as Initiation Humour and Laughter The Patient Cluster The Display of Madness Summary Discussion —

Chapter Four Dialogues of the Classical and Grotesque Body: The Unofficial Terminology of the Care Chronotope The Re-arrangement of the Body Terror and Care Sleeping Words The Smoothing-out of Official Ends by Unofficial Means The Surplus of the Third The Aesthetics of Fragmentation Discussion and Dialogue

Chapter Five Encounters with the Grotesque The Distractions of Seeking Grotesque Definition Mrs Dryden’s Pear The Primary Position The Secondary Position Discussion and Dialogue Alibis and Responsibility

Chapter Six Madness and the Grotesque Chronotope Discovered Fellowship

52 52 53 53 56 60

62 68

73 74 77 80 83 85 88 91

97 98 103 104 106 106 108

113

116

Contents

xv

Chapter Seven

The Practitioner Patients Primary and Secondary Positions of the Care Chronotope No-man’s Land Through the Gates of the Patient Chronotope The Unofficial Landscape Discovered Fellowship

123 125 128 130 132 137

Chapter Eight

The Pseudopatients Finding Oneself in No-man’s-land Encountering the Grotesque The Timespace of the Patient Chronotope Clinging to the Wreckage: Space and Invisibility Through the Gates of the Patient Chronotope: Discovered Fellowship The Case of William Caudill and the Circles of Parody The Circles of Parody An “I-experience” or a “We-experience”? Pseudopatients: Summary and Discussion

143 147 149 151 153 156 160 162 169 172

Chapter N i n e

The Pseudopatient The Visit Intermezzo Admission Discussion Timespace Language Found Fellowship

181 184 191 192 202 203 205 208

Chapter Ten

Consummation Polyphony Icons

21 1 212 214

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xvi

What Relevance has Polyphony to Psychiatry? What Potential is loaned to the Practitioner by Polyphony?

Appendix One Student Cluster Patient Cluster Competing Theories Miscellaneous

Appendix Two Unofficial Terminology Collected from the Introductory Lectures to Psychiatry given to Medical Students

Index

216 219

227 227 23 1 235 236

237

237

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Language for Those Who Have Nothing Mikhail Bakhtin and the Landscape of Psychiatry

Introduction

PREAMBLE Psychiatry is structured by its own system of topographical consciousness. The unchanging nature that psychiatry continues to manage mental illness stems from a legacy bequeathed by the Victorian commitment to bricks, iron railings and grand clock towers. The modem bulldozer may well have reduced the asylum tower to rubble but the old images still impress themselves upon the polished pine corridors of the new clinics. The old clock still surveys its landscape. It is as if all those buildings that made up the drab wards are still bustling with their daily routines. It is as if groups of patients still promenade along avenues lined by stately trees and manicured lawns. And in the sight line of the clock tower the well-tended plots of the hospital farm change only with the seasons. There is a quiet Englishness, in a very colonial sense, about all this. A landscape arranged by systems of hierarchies that says something completely obvious to itself. It would almost be an impertinence to question this organisation. If I peer over the asylum wall and look onto this land I am moved by three impressions. The first is that this is a living landscape. Life is not only to be seen in the people who populate the pathways but it can be seen and it can be felt in all the structures that make up the asylum. The stairways and the offices and the great corridors are all saturated by the memory of previous and present bodies. Secondly, I am aware that not everything works in time to the chimes of the official clock. There are living things here whose voices are shaped by different senses of presentness. My third impression is that there must exist an alternative method of finding a way 1

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Language For Those Who Have Nothing

through this landscape. Apart from formally introducing myself at the main gate there must be other, more creative, means of exploring this settlement. What would happen, I wanted to know, if I gently eased myself over the wall and forced myself to find a different way of navigation? Psychiatry is a living landscape. There are many standings here and real living bodies occupy these spaces. Certain bodies are powerful enough to draw others into their orbits of meaning. And it is proper that much activity surrounds these standings. For the alert visitor there are many voices to be heard. Some of these voices are deemed to be official and others are considered to be unofficial. Occasionally one body will move to another body and take on the voice of that standing. Such movement does not always represent an ideological shift. It can occur two or three times within a single utterance. I note that as well as a number of standings there are a variety of nows embedded in different spaces. In many places time proceeds in ways other than that directed by the asylum clock. This book is an account of what happened to me after I jumped over the wall. But before I did this it was first necessary to consult the curious writings of Mikhail Mikhailovich Bakhtin.

BAKHTIN Mikhail Bakhtin was born in 1895. He was educated at Odessa and the University of St Petersburg, the latter coinciding with the events of the 19 17 Revolution. The early years of the new Soviet State, though full of deprivation, was an exciting time for intellectual groups. One such school gathered around Bakhtin and went on to produce two significant books: Medvedev’s The Formal Method in Literary Scholarship, and Voloshinov’s Marxism and the Philosophy of Language. Towards the end of his life Bakhtin was to claim that these works, published under the names of his two friends, were his own. Bakhtin’s first published work – Problems of Dostoevsky's Art (1929) - led to his arrest and exile in the remote region of Kazakhstan. Always in ill-health – he had a chronic lung disorder and lost a leg in 1938 – he survived on rough Russian tobacco and mugs of strong tea served by his devoted wife, Elena. He was to remain in exile for almost thirty years. At the end of the Second World War he submitted his famous carnival thesis on Rabelais, though as a book, it had to wait a further twenty years before being published. Slowly, and as political oppression lessened, Bakhtin’s work began to be published and, in the early 70’s, the first translations appeared in the West. His gradual rehabilitation permitted the ageing couple to take up residence in Moscow in 1969. Bakhtin died there in 1975 aged 80.

Introduction

3

I confess that what first attracted me to Bakhtin was that he was one of only a handful of independent thinkers who managed to survive the most oppressive regime of recent times.1 Many lesser and more conformist intellectuals, including most of the Bakhtin School, were put up against a wall and shot or exiled and forgotten. I was quite curious to discover what lay within his character that made his survival possible. In one way, the fact that he lived and wrote under these conditions gives some account as to why he has become a model to those who concern themselves with the plight of the maginalised voice. In turn this explains why his writings have spilt over into a range of disciplines that perhaps Bakhtin never intended. But there is also another important variable hidden within the means of his survival and one easily forgotten in the cut and thrust of critical debate. Namely, Bakhtin could have only written what he wrote with an eye on the page and an ear for the knock on the door. Those commentators who forget this do Bakhtin a great disservice. Mikhail Bakhtin is one of the most creative philosophers to find a home in the twentieth century. His still rising intellectual profile demonstrates his power to extract new meaning from the ways people stand in relationship to otherness. His work challenges the conventions of social organisation in which its basic components are given an interactive status rather than a hierarchical ranking. The terms associated with his name – the carnivalesque, polyphony, dialogism, – have proved themselves to be resourcefdul concepts well equipped to investigate the complexities of contemporary experience. His themes are advanced from a position untouched by a complacent relativism and they carry no confident exposition that some political alternative is standing by. He writes in a very different intellectual tradition from the Western canon. His is a blend of dense NeoKantian philosophy, the enduring wisdom of the Orthodox Church and the freshness of Marxist ambition. Bakhtin combines these influences in a way that is bold in its novelty yet often bewildering in its ways of reasoning. He yields many illuminating insights, but these are gains bought at a price, at least to Western eyes, of a radically incomplete picture of the human condition. The demands for closure and definition will find no comfort in Bakhtin's promotion of the ever-becoming nature of humanity. And the practice of adversarial or competitive argumentation, that so sets the tone of contemporary debate, will find no willing contestant in Bakhtin. It is more likely that his differing styles, his repetitions and his continually shifting meanings will challenge the reader to adopt a stance of activity to his texts. His concepts are not to be passively perceived but actively and dialogically engaged with. Dialogism, the activity binding all Bakhtin's work together, is to be understood as a living contribution of at least two consciousnesses. In every utterance the other makes a form-shaping contribution, and both the

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Language For Those Who Have Nothing

speaker and the interlocutor carry a responsibility and answerability in the unfolding dialogue. Hence, context – and it is always human context – plays a dominant role in a dialogism that breathes activity between people. Bakhtin develops dialogism against the shadow of monologic discourse where the voice of the other is not required. The authoritative elements that make up this discourse are seen to be separable from the person who utters them. Such disembodied thinking seems intent on pursing closure and the shaping of meaning drawn from some all-embracing system. It is characteristic of monological languages that they will seek to impose limits upon those languages that cannot be brought into its gravitational orbit. To such unitary languages the sheer diversity of other languages are irritants whose proximity and influence must be limited. Bakhtin’s commentaries on the human condition are contained in his surveys on the novel. He prefers to see life lived alongside differing paces of time and the connection it has with social space. Community becomes an interdependent collection of differing timespaces that are form shaping upon each other. The everyday activities of human life are judged to be messy and are reluctant to be fitted in to some systematic explanation. Indeed life itself is positive and the individual is always in a state of becoming with the potential for growth and development always at hand. Bakhtin uses the metaphor of a community being a ‘line’ interrupted by transformative ‘knots’ at certain sequential points.2 His interest is not in the progressive ‘line’ that separates these events but in the spiralling movements of space and time that form the ‘knots.’ As Ken Hirschop3 points out, the implications for a Bakhtinian historicism are not to be found in the ‘preceding and following social structure’ that draws the line between the knots, but in the twisting proximity of spaces that must necessarily intervene in all rational progression. Hirschop is correct at this point to separate the carnival from any revolutionary ambition. The old medieval carnival is not to be represented as a knot in the line ‘in which the new struggles to supplant the old’ but more as a temporary and even licensed interruption to the flow of the ordered world. The suddenness, in which these knots tie and untangle themselves, is a key temporal feature to which I will frequently refer. It is sufficient for now to note that once the knot is untied the forces that so powerfully enabled such proximity are immediately jettisoned by the official regime and the previous linear direction is resumed. The focus of my enquiry is on the reduced powers of this discarded material and how it continues to make it's presence, felt on the official psychiatric landscape. Within this metaphor of lines and knots Bakhtin held a deeply personal ideal of human community. It was an ideal strongly filtered through his own faithful, if unconventional, dialogue with the Russian Orthodox Church. It should be noted that Orthodoxy was only obliquely affected by the

Introduction

5

upheavals that raged through Western European history. Entirely missing from its tradition are the cultural shifts of the Reformation and the emergence of the new humanistic individual.4 Not only is the perspective of Orthodoxy different from the West but the questions it asks begin from a different starting point. The Westem reader can expect some novel insights from this dialogue and Bakhtin, committed to becoming and to potential, does not disappoint us. His own intellectual development grew from a time when the church and the revolutionary commonly shared the same public platform.5 Unfortunately, Bakhtin’s faith in a spiritual sobernost extended well past its sell-by date. In 1929 his connections with the church led to his arrest and exile. Yet this period when the priest and the revolutionary spoke from the same platform represents a point in Russian history that held real hopes for a society built from an ecclesial past and a revolutionary future. It is Bakhtin’s dialogue with Orthodoxy that reveals the tension - pervading all his writing - between the values of the ancient collective body and the standing of the modem individual. For an early Church Father, Nicholas Kavasilas, the concept of Western autonomy – ‘for man to see himself as sufficient in his own’ – was a sin reminiscent of Adam’s wish ‘to live independently from God. And, indeed, the growing insufficiency of the modern self to engage with others on a relational basis confirms the fears of Kavasilas. Indeed, one of the difficulties for the Western mind in understanding the potentials of Bakhtin’s dialogism can be attributed to a bodily standing pre-occupied with privacy and individuality. But Charles Taylor6 has suggested, rightly, that few would want to go back on the achievements of modem individuality. Our choices, our sense of personal control and independence are hard-won values and we are correct to defend them. Yet Taylor’s argument is only possible against a nagging voice that suggests we have lost something by breaking away from the wider order of things. This loss has led to a lesser concern with others and a narrowing of focus onto the concerns of the private self. Bakhtin’s writings are at there most inspired when they are immersed in times when people were held together in a mutual dependency upon one another. For him it was a tragedy when a pre-class wholesome community became fragmented by an ego-centred individualism. He mourned most for the loss of the publicly visible collective voice. But Bakhtin cannot be understood in the terms of a nostalgic revival for a long lost historical community. The forces that once so capably bound relationships together in such a different way to those strung out for us on today’s monological lines are recognised by Bakhtin in a domain that is still capable of reconnecting the body to the social and the social to Mother Earth.

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Language For Those Who Have Nothing

THE MATERIAL BODILY SPHERE Not only does the bond between man and man come to be forged once more by the magic of the Dionysiac rite, but nature itself, long alienated or subjected, rises again to celebrate the reconciliation with her prodigal son, man. Nietzsche, The Birth of Tragedy Bakhtin anchors the unity of humanity and the earth through a specific domain – the Material Bodily Principle.7 He infuses this sphere with flesh and blood portraying it as a highly mobile set of tensions in a state of constant decay and renewal. In fact we can extract a central dialogical theme in the way these relationships negotiate positions for themselves. Namely, that dialogism can be seen as how answerability works when differences become gathered together. At its most extreme, this collective body imagery of this sphere, with all its earthly connections, can be represented in the ever-becoming celebratory carnival body. As the most vivid of collective bodies, the carnival body, entirely at home in the Material Bodily Sphere, locates the focal point of its powers in the lower bodily strata. The body’s own life-giving and life-taking orifices, its emissions, its births and its deaths are the leading themes of the Material Bodily Sphere. It can be said that the standing of the modem body is built by separating the rational head from the functions of the lower bodily strata. This means, of course, that perspectives that begin from the lower region cannot be evaluated in the terms of the rational head. The voices that speak from the Material Bodily Sphere are rarely to be found in alliance with social justice or in visions of some abstract equality. As in the medieval carnival, the forces of lust and hostility are celebrated as much as the joys of song and revelry. In severing its link with the body the rational head has developed an attendant capacity to maintain a degree of social detachment. I intend to show that this capacity has become so refined that surrounding events can be made invisible or inaudible. But despite this identity-maintaining capability, I can also demonstrate how the rational head has considerable difficulty in refusing the contributions of the Material Bodily Sphere. Inverting the topography of the body has consequences upon the way the world is seen. Any perspective from this lower level means that the body must surrender its primary dependence upon the rational gaze. The American critic Robert Stam8 has identified the prominence of aural and vocal metaphor in Bakhtin’s thinking. He describes how Bakhtin’s use of voice, heteroglossia, and intonation come to take an importance over visually gathered perspectives. Again this cognitive inversion can be seen in

Introduction

7

the Material Bodily Sphere where the rational gaze of the individual observer is pulled down into the participatory sensuality of the collective body. As with the carnival, this region of meaning makes the most powerful challenge to the visual. Those privileged sites of observation, so common in the official world, are not available here. But Bakhtin never rejects the visual. It is true that is primary focus is upon the dialogic voice but his writing is rich in powerful metaphors of refraction, prisms, and the visual surplus of seeing. It would be more correct to say that Bakhtin collapses the sensory hierarchy into a mobile constellation of awareness. Any reading of his texts will find the concept of the voice combined with strong sensory connections. Languages have ‘flavour’ (DiN: 305), words ‘taste’ (DiN: 292) of their influences, we ‘sense’ the activity of a language (DiN: 295), or a language is ‘infected’ with ‘intention’ (DiN: 290). The visual is neither favoured nor excluded, it is merely brought into the range of other mutuallydependent perceptions. To avoid the danger of isolating the Material Bodily Sphere from a rational landscape I propose to consolidate its presence in the form of a background to the reality of everyday life. To do this I will frame this sphere as a living background that can be recognised by its audible and vocal character. Michel Serres’s9 work on the audible nature of chaos strikes a convergent chord with the idea of the Material Sphere. Serres creates his background from the Old French word for noise – bruit – ‘the furor, the tumultousness of things and rivalrous dissension among human beings.’ He invites us to ‘peer into the manholes’ that contain the source of this noise and to even participate in the patchwork of chaos bubbling below. Should we risk transgressing the protection of the manholes we will suddenly find ourselves participating in everything the ordered world would consider as ‘impure, improper, irrational.1 If I transform Serres’s metaphor from chaos we are given a complementary insight into the ever-becoming forces of the Material Bodily Sphere. But in complying with Serres’s invitation to only ‘peer’ into this world we restrict ourselves to one form of perception. The power of the rational gaze has the tendency to confine us to assumptions that unstable events can be harnessed and made to fit into unitary systems, or at least, binary oppositions. As old as ordered time itself, the marginal voices of society have sought shelter in this world of rumbling background noise. For Bakhtin, the voices that are heard here are the ‘eternally living element’ of social discourse and carry ‘a life without beginning or end.’10 Like every speech form these voices are replete with their own wisdom and their own way of dealing with the world. If we accept this background murmur to everyday life then it is enough to give us a certain amount of scepticism in approaching unitary voices. In Bakhtin’s work on the carnival he noted that Rabelais’s text fully

8

Language For Those Who Have Nothing

intermingled the background noise with the official word. So powerful was the threat of the Material Sphere to the birth of the humanistic culture that a newly emerging rationality was forced to develop the ability to render – mostly low – events invisible. If I update this formula then I am tempted to claim that even the most reduced forms of lower bodily meanings demand a reciprocal response from the rational head. Even from the most indirect or subtle expression there is no real escape. The fart at the case conference smells simply for the benefit of the deaf. Or for those who refuse to hear it. Thus, let me summarise the spirit of the Material Bodily Sphere – or, in one of Bakhtin's many sudden shifts of definition – the aesthetic of Grotesque Realism. It will be seen that this huge and clamorous sphere of meanings carries its own loose but driven energy. This background noise, ever ready to unsettle, invert or interfere with commonly held values, is there to remind us that life cannot be understood purely by reason alone. Its activities of laughter and low idiom captures an ancient imagination. A collective body immediately understands every one of its jokes, its crude terminology's, and its lewd gestures. Occasionally this noise becomes so loud that rationality cannot ignore its presence. At these times a unitary language activates a number of tested responses – suppression, modification, or a further distancing practice. The logic of this sphere is a troublesome presence, yet in the terms of its own ambivalence, it is also a living thing. It grows and it contracts, and it will object noisily to being enclosed within a definition.

WHAT POTENTIAL IS OFFERED TO THE TRAVELLER BY THIS REALISM? To understand the meaning of these fragments of half-dead forms is possible only if we retain the background of grotesque realism. M.M. Bakhtin11 The answer to this question lies in a willingness to construct novel and unexpected connections that breach the more usual methods of travel. To put this question into perspective we could note that there is a nagging contradiction in taking seriously a Langian perspective of psychiatry, or even a Foucaldian critique of institutional rationality, and at the same time hope to avoid uncomfortable encounters by resorting to a voice of analytical detachment. To consider conducting oneself in such a critical manner would be to place oneself in a position of confrontation. In order to deflect the impact of such recklessness the traveller must develop a more oblique

Introduction

9

method of engaging the landscape. To fully realise the potentials of encountering bodies as powerful as psychiatry it will be necessary to work with voices constructed by the forces of deception, mockery, or acts of cunning. Such qualities find their value in the times of all threshold encounters. And as Rabelais reminds us, these forces of grotesque realism were the only ones powerful enough to combat the grinding Gothic ideologies of the Middle Ages.12 The voices of the Material Bodily Sphere are so much a part of everyday life that its sound is both familiar and distant. Familiar, because after all, it is our habitat in which we, like our words, must move and breathe within. Distant, because we continue to conceive of this noise as somewhere else, in a space constituted otherwise to our own. But it is important that we see this noise as being set within the ecology of the social voice. Every single word is a word borrowed from the ‘agitated and tension-filled environment’13 that makes up the social world. Words do not belong solely to ourselves, they are not the property of any one individual; they belong to the context of the social encounter. Each word we take from and return to the fold belongs not only to ourselves but also to the voice of the other to whom we address our meaning. And it is because they are so fundamentally social that we must recognise the shared quality of our utterances. In Bakhtin’s word-world, every word has already been spoken and every word is ‘shot through with shared thoughts, points of view, [and] alien judgements.’14 What gives words their uniqueness is the life given to them as they become invested within our body. Every single utterance we construct is loaded by ‘our eyes, lips, hands, soul, spirit, [our] whole body and deeds.15 Once we remove words from this living context they begin to fade (become ‘naked corpses’16) and are buried in the graveyards of dictionaries or in the ‘half-dead’ abstract systems of linguistics. Over time certain arrangements of words take up particular intentions and form themselves into genres. Genres, recognisable social voices, are formed from words knitted together by their accumulated wisdom and beliefs. They have their own social appropriateness and are guided by specific structures of time and space. As with words, genres are made alive by the people who use them. Professionals and pundits, traders and lovers, the youth and the aged, all demonstrate a particular way of embodying reality. Of course any potential interplay between these voices is hampered by the social stratification of their value. Every landscape is characterised by linguistic gravitational orbits that pull, or deflect, other voices into its range of influence. Dominant genres, as already noted, decline to enter into dialogue with voices outside of its own orbit. The claimed unitary nature of these powerful genres is considered sufficient to give meaning to the world. The unitary word demands an allegiance that means particular utterances become

10

Language For Those Who Have Nothing

part of the body itself. Bodies are built by their utterances and they confirm for the individual, and for others, their social standing on the landscape. Such an ecological arrangement of voices invites a number of questions for the landscape of psychiatry. In themselves these questions are highly suggestive of a new potential and a different angle of approach. To begin, we could ask what happens to dialogue if the bodily components of an utterance are suddenly inverted or distorted? What must be unlearned or discarded in order to step away from the genres that construct our body? What effect would the wilful denouncement of ‘hierarchical ornamentation’17 have upon the ceremonial performance of a professional standing? What would happen to the value of a professional standing if it were embodied into a dialogue with voices of the Material Bodily Sphere? Would psychiatry gain any advantage by entering into dialogue with voices outside of its own standings? And would this knowledge be valuable or even useful? And finally, how does one become genuine towards a unitary language and is there apermissible role for a methodology of difference; one that could fully engage the voice with the form-shaping negative aspects of an official voice? With these questions in mind my first task must be to find a means of listening-in to the oral traditions of the psychiatric landscape. If I can do this successfully then it will be possible to track both the isolating features and the form-shaping forces that make up the official voices. Bakhtin’s great value is in the assistance he offers through his concepts of the Material Bodily Sphere, the chronotope and the practice of polyphony. By developing and extending Bakhtin’s ideas I intend to secure a novel means of mobility on this terrain. My greatest danger is that by staying only with time-trusted levels of dialogue I will never put at risk my own uniqueness.

THE OFFICIAL LANDSCAPE OF PSYCHIATRY There is an apocryphal saying that in order to pass the membership examination of the Royal College of Psychiatrists, Jaspers name should be invoked at some stage, preferably being followed by a comment as to the great significance of his General Psychopathology and of how much is lost in translation. P.J. Harrison18

The low voices that rumble away in the Material Bodily Sphere are a perplexing and irritating subject. As a consequence there is an uncertainty in accepting its agenda as a suitable one for discussion. This is particularly so

Introduction

11

for a disciplinary body that is required to conduct itself with propriety and a sense of measured authority. Outside the remit of symptomology, the background voice of jokes, crude terminology, and unseemly laughter are considered at best an entertaining distraction but of little significance to the pressing clinical tasks in hand. Psychiatry, rightly, occupies a space that represents the serious assessment and management of mental illness. Allon White19 has made the important connection that seriousness, and the authority to designate what is serious and what is not, is a constitutive feature of all unitary languages. For the unitary voice, seriousness is associated with truth, and where there is a need to actualise the authority of its language the demeanour of seriousness creates a confidence in the way that utterances are shaped. Thus, in every official space on this landscape a serious consideration, coupled to a studied and genuine concern, has become the proper formula for conducting clinical encounters. Psychiatry has adopted this stance in its efforts to keep in step with the more forceful march of scientific medicine. But, wisely, psychiatry exercises a certain reserve in promoting its practices before a doubtful public. Even the grand parade of scientific medicine must nowadays march through gaggles of spectators generally suspicious of privilege and official authority. It would seem that every development in official science is fated to be parodied by contrary beliefs in alien life forms, organic foods or exotic healing techniques. How long, this chorus of voices is chanting, must we life lives without spirituality? How long must we live without the recognition of irrationality as a contributory element to everyday life? I shall return in later chapters to the relationship of parody to the official creed but before doing so I must sketch out more of the official landscape. If Bakhtin continually refers to the hero – though he means the term more as a leading other – then Karl Jaspers (1883-1969) is one of the great heroes of contemporary psychiatry. Heroes have always played an important role on uncertain landscapes and unitary voices have always reached back to the ancient classical body to bolster the standing of its more revered colleagues. At the most elegant points of institutional space – the grandest offices and the red-carpeted entrances – psychiatry's heroes are to be found elevated onto the plinth or within the gilded frame. From there, in a familiar classical pose, these noble bodies symbolise the serious qualities of authority and endeavour. The steadfastness of their penetrating gaze silently articulates a narrative whose contents are rarely open to debate. From these elevated standings the watchfulness of the hero radiates a power that must come to be grasped intuitively by aspiring practitioners. Such monological dialogues take place, appropriately, in the most hallowed spaces of the official landscape. And in the permanence of their standing their presence becomes closely bound up with the merging of a hesitant voice into the

12

Language For Those Who Have Nothing

security of a wider body. The isolated voice is vague and formless and bodies are solid, properly proportioned and of obvious standing. As far back as 1913 the impact of Karl Jaspers’s General Psychopathology20 was recognised as a notable event in the history of psychiatry. Throughout central Europe the book was seen as a unique achievement, ‘a mountainous landmark in the history of the subject.’21 Mainly because of the opaque concentration of its arguments – in German as well as in translation – this great textbook was slow to gain an influence with English readers. Nonetheless, Jaspers’s work was to have a ‘profound influence on British psychiatry, ’22 particularly through the work of MayerGross and Aubrey Lewis. Indeed, many of the most prominent voices in British Psychiatry – Schneider, Kraupl-Taylor, Fish, Anderton, readily acknowledge Jaspers to be their most lasting of influences.23 Such reverence towards a hero denotes the on-going dialogue that preserves and passes on a genre. The values embodied by Karl Jaspers, modified to our own time, continue to guide the way psychopathology24 is managed. According to Manfred Spitzer, Jaspers’s legacy ‘can be shown by the fact that some of the basic principles of today’s psychiatry can be traced back to his thoughts.,25 As a hero Jaspers remains a significant voice on the psychiatric landscape. Jaspers’s approach to early twentieth century psychiatry was, to say the least, robust, but one entirely befitting a heroic project. As a young man in 1908 he secured a position in the Heidelberg clinic where he found himself immediately pitched into a chaotic word-world: Frequently, the same things were being discussed in different terms, in most cases in a very obscure manner. Several schools had each its own terminology. It seemed as if several languages were being spoken, with deviations to the extent of special jargons at the individual hospitals.26 With an admirable vigour Jaspers was to formulate, in his General Psychopathology, a new unitary language whose authority was dependent on the silencing of other competing voices. Jaspers gave to psychiatry a professional genre that permitted no accommodation to lesser or marginal voices. Chatter, irrelevant abstraction, and administrative untidiness were to become the enemies of his new methodical consciousness. ‘Everywhere’, he wrote, ‘I fought against mere talk without knowledge, especially against “theories” which played such a big role in psychiatric language.’27 Jaspers is scathing in dismissing the contributions of other voices to the management of psychopathology. His own voice is one still actively cultivated by his disciples. A typical example is to be found in G. M. Carstairs respectful introduction to Kraupl-Taylor’s Psychopathology.28 The reader is cautioned that Kraupl-Taylor is one who conducts himself in the tradition of Karl Jaspers: ‘a person who abhors muddle, confusion and all forms of intellectual untidiness. ’

Introduction

13

In formulating a new language Jaspers’s greatest contribution to the psychiatric landscape has been the consolidation of the practitioner’s standing. Certainly, there are other heroic influences to be found in psychiatry but none has had such a lasting effect of providing the principle code to identify a practitioner. Therapeutic practices that describe themselves as analytical or positivist or biological have all come to share in a privileged point of consciousness more profound than the differences that divide them. Jaspers gave to the standing of the practitioner an enhanced scientific voice which was grafted onto an authority that had since the time of Tuke and Pinel relied on the personality of the physician. In effect Jaspers modified an earlier neo-classical standing by giving the body a voice confident enough to speak with the unitary certainties of science. He conferred upon practitioners the option of making psychiatric symptoms visible, either by external observation – Explanation - or through the empathic process of Understanding.29 Jaspers’s great triumph lay in giving a scientific credibility to the practitioner’s intuition. Where previously explanation had been the approved means of presenting a viable account, now the voice of intuition (Verstehen) was given a free reign. Jaspers had moved the standing of practitioners onto a more solid – but more unaccountable – foothold. Verstehen became part of the practitioner’s body and gave it a scientific facet to its previous gentlemanly standing. Properly embodied, the intuitive voice is a voice that is turned inwards and addresses itself directly to the self-reflective responsibilities of the practitioner’s experience. The old authoritative gaze is now refracted through a new scientific thinking vision. The watchful and silent commentary of a unitary language invests the gaze with access to the deepest meanings of the subject it encounters. Jaspers: [T]he doctor will break off communication unnoticed by the patient and on his behalf. since it is the doctor who now controls the limits, the doctor draws inwardly to a distance (though he does not show it), takes the whole individual us his object unci weighs up the effects ofhis entire therapy within which every word will he controlled.30 By breaking off the potentials of dialogue Jaspers is retreating into a monological realm of dialogue. From this point onwards the practitioner’s voice is unavailable to the anticipation of the other and for all intents and purposes the interactive aspect of the dialogue has been closed down. Jaspers’s thinking vision is a voice that finds a home in a number of modem closely defended concepts. Unburdened by the fashion for critical assessment the voice of the Verstehen lives on under the rubrics of descriptive phenomenology, clinical autonomy, or clinical ,judgement. Yet Jaspers imposes strict limits on the practitioner’s standing as well as on the

14

Language For Those Who Have Nothing

patient’s voice. Verstehen is embodied only by the elevation of a body onto a Neitzschean level of elitism. For Jaspers, only ‘exceptional personalities’ who can rely fully ‘on their own resources’31 are acceptable as candidates to fill the new role of the psychopathologist. Built into the new body is a heroic and classical insistence that the inner development of a practitioner is a solitary and lifelong project. A process that is certainly not subject ‘to examination or assessment by others.’32 It is only through the solitary elevation of this standing that Verstehen can be further refined. Jaspers’s requires the practitioner to ‘grasp immediately’33 the meaning of the array of presenting symptoms in a clinical encounter. Verstehen must be direct and immediate in the same way that the perception of any object is direct and immediate. And immediacy is maintained by refusing to permit one’s understanding to stray across limits that cannot be made visible. To do so is to dabble, unforgivably, in the treacherous regions of the ‘ununderstandable.’34 And Jaspers is ruthless in the precision of Verstehen. This thinking vision must become adept at removing ‘the rubbish of meaningless observations’35 from the development of the clinical picture. To concern oneself with ‘ununderstandable’ speculations upon meaning is ill advised and represents an untidiness of vision. And at those times where the symptoms of madness are deemed to be ‘ununderstandable’ then consideration should be passed over to description alone. The mad are to be shaped by their biographies and refracted through a descriptive methodology. Here, precise and exact description will suffice. Time is saved. Spaces are made tidy. There is to be no dialogue with the mad. Those bodies that carry the power of Verstehen give to the psychiatric landscape a useful narrative structure that is theory-free, apolitical and administratively tidy. All of these variables support the institutional need to appear neutral in a world full of complex demands. Yet this position makes further demands on the standing of a practitioner. Jaspers is adamant in the separation of the standings of healers and sufferers. The standing of the practitioner must be entirely ‘unambiguous’ and ‘a patient is thus and no other.’36 A practitioner is here on one part of the landscape and a patient is over there on another part. Such standings are to be clearly visible and understandable to everyone: ‘A sick person should be helped. A doctor is there to heal.’37 Such an unambiguous relationship denies the potential of dialogue and forces the practitioner even further to rely upon his own inner resources. Within the institutional heritage of busyness, resource, and hierarchy – landscape I will come to describe as the Care Chronotope – the practitioner actively contends with the presentation of symptoms that demand some form of resolution. Confronted with a midnight emergency admission of a young black guy, flanked by two constables and accused of shouting up at lamp

Introduction

15

posts, the freedom of Agnostico – I do not know – is a freedom denied to the practitioner. There is no freedom of dialogue in clinical judgement; only a practised clinical certainty. After all, the landscape that is psychiatry expects a proper return from its investment. Decisiveness, judgement and leadership are the required outcomes from the immediacy of Verstehen. Indeed to act against the will of the hapless black guy requires a certainty of vision and the ability to inwardly withdraw from the irrelevancies of his protests. For the practitioner must be certain that their interventions are right and be prepared to enforce these judgements even when this help is being rejected. The leading conceptual theme of clinical judgement – the immediate appraisal of an encounter – is built not only by experience but also by a strong moral certainty. There are ways of thinking and ways of behaving that are expected of the neo-classical body. Yet a standing that insists upon a detached but moral character implies a neutral position to the wider world. The psychotherapist Paul Gordon,38 in a polemical essay highly critical of the paucity of political activity, allows that in attending to mental illness on an individual basis the practitioner is able to deflect a confrontation with social issues. Indeed the practitioners who daily manage mental illness are faced by a thankless task. They labour between two seemingly impossible social forces. Psychiatry’s primary task is identified with the control of mental illness yet its own survival is dependent on the ability to promote a public form of stability. Inevitably, the vulnerability of this tension generates a pronounced conservatism as a characteristic of its own topographical consciousness. And despite all its scientific and analytical developments the landscape of psychiatry continues to manage mental illness in the same unchanging way. The (sometimes desperate) allegiance psychiatry has towards scientific medicine only hardens its commitment to conservative social goals. We can only speculate on how we would read this landscape had psychiatry chosen to construct itself in alliance with the poor, or with monasticism, or with education, or to programmes of creative employment.

BAKHTIN AND THE PSYCHIATRIC LANDSCAPE The value of Bakhtin as a guide is that he allows the traveller to reveal a side of the landscape that cannot be fully expressed by an official language. Bakhtin will not permit the traveller to become deaf to the background voices of the Material Bodily Sphere. Consequently, he makes us aware of how every voice, official and unofficial, provides a form-shaping contribution to clinical practice. And because my starting point as a traveller is always located within the social voice I am able to see that the stabilising

16

Language For Those Who Have Nothing

influences of psychiatry are often external to the reasoned linear development it might otherwise prefer. At every stage of my journey I will make playful assertions that official ends are being met by unofficial means. I have already proposed that the strongest gravitational pull on this landscape is the voice consolidated by Jaspers’s embodied thinking vision. All other languages must be marked-off against the authority of this prominent landmark. Of course, over time, the unitary language of psychiatry does change, partly through its own efforts, but more frequently, as a response to outside political pressures. Over the past two decades, and for reasons possibly unhelpful to psychiatry, there has been an imposition of a new administrative system onto the discipline. Governing bureaucracies, sometimes over-sensitive to litigation, have established their own powerful orbits of influence. And new voices, refracted through Health and Safety regulation and specialised Codes of Practices, have made themselves daily points of institutional reference. The older forms of hierarchy are under constant challenge as a commitment to consumer choice and rights gains a popular foothold. Psychiatric nurses are increasingly shedding their traditionally muted voice and are taking on the voice of advocacy with all its earnest tones of fairness and individual rights. But one knows that as soon as a practice goes wrong there is a swift and merciless return to the core unitary language. Indeed this landscape is alive with a variety of emerging voices struggling to negotiate positions in mire of changing management structures. It is this living mobility of languages that will form the substance of my journey. Along with Bakhtin I am able to ask whose voice is speaking and what is thefunction of that voice as opposed to its content? And further, whose intentions does this voice serve and in what set of circumstances is a voice heard and a voice not heard? Bakhtin will also provide me with a number of useful travel chronotopes - the time and space co-ordinates that structure every narrative. Voices have meaning only in the context of particular times and spaces and an understanding of these different timespaces will greatly assist me. Like every good traveller I adopt a generally conservative approach to the land I will visit. I have no special conclusions about what is good or bad in psychiatry. Bakhtin reminds the traveller that they have a duty to leave ‘everything in the world in its place. [The traveller] does not alter the social face of the world, nor does he restructure it.’39 Accordingly, I will leave mainstream clinical definitions undisturbed and accept its everyday practices with good grace. Yet another Bakhtinian concept – polyphony – will demand that I approach others as if they were free and unfolding personalities. Polyphony discourages me from visually driven face-to-face contact in preference to encounters that evoke new metaphors of dialogical relationships. As a

Introduction

17

traveller I am required to alter my own position in order that I may place myself alongside another’s voice. Through this mobility polyphony establishes a distinction between approaches that seek to compel things into an order and those that carry a degree of respect for otherness that can seem to extend to recklessness. In polyphony there is an element of fatalism that recognises every attempt to control the world is condemned to be outflanked and ultimately turned back on itself. But this does not commit polyphony to relativism. There is little point in entering into a dialogue if there is no truth in one’s standing. It will be seen that polyphony collapses the more conventional either/or aspects of augmentation. So often competitive discourse is found to be playing down the potentials of open-minded dialogue in favour of interruption or the winning of arguments. Competitive argument is characterised not only by its determination to explain events in its own unitary language but also in its attempts to isolate or exclude otherness in order to demonstrate a triumphant clarity of analysis. It is more likely that polyphony encourages participants in a dialogue to build upon a relationship rather than seek to uncover an underlying or casual explanation. Instead of the conventional either/or structure polyphony presents us with a new both/and axis. For the polyphonic traveller is means there is no ambition to replace one form of discourse by another. Polyphony directs psychiatry to add to or widen the circle of perspectives it otherwise strives to distance itself from. It follows on from this that polyphony only agrees to take the participants of an encounter to the threshold of surprise and the unexpected. There is no contract with Bakhtin to engage with a systematic prognosis or a unitary closure. The direction of my journey corresponds with the carnival practise of temporarily displacing high abstract ideals from the authority of their standing and immersing them into the noise of the Material Bodily Sphere. This Sphere is a space in which travellers can suddenly immerse themselves into, or with equal suddenness, detach themselves from. An irreverent pattern of mobility is established by which the high transfers to the low and is then returned back to its high standing. Everything that is high and abstract is brought down into the low in order that its ideals may be rebuilt and returned to a previous standing. In polyphony these movements can be met at various degrees of descending or ascending activity. This means that different levels of analysis become available rather than those to be found in the more conventional linear methods. Polyphony has no real centre, no real beginning or ending. My early chapters are therefore concerned with the merging of Bakhtinian formulations into the thinking of official psychiatry. From here, I will proceed in a series of step-downs to explore this abstract relationship on the lower levels of the landscape. I should emphasise that the idea of a theory of polyphony must possess an organic, bodily,

18

Language For Those Who Have Nothing

connection to its reasoning. The relationship of the observer has to break away from its spectator status. Because what happens in these step-downs is something that is located in the living voice of the body as it relates to otherness. The body plays such a key element in polyphony that this relationship cannot always be distanced by objective criteria. Bakhtin’s work is there to be actively engaged with and developed. To travel polyphonically is to learn to read a landscape in the company of some improbable voices. My own dialogue with Bakhtin has fundamentally altered the way I see mental illness and the means by which it is managed. I am increasingly aware that the way psychiatry continues to manage psychopathology is one driven by a need to become more and more exact. This very determination means that the background voices on the landscape are made to become more muted, more insignificant. I believe it is a paradox that the more and more correct observations we accumulate the less and less we seem to know what it is that is worth living for and what it is that makes us all unique. Groys, B., ‘Nietzsche’s influence on the non-official culture of the 1930’s’, in Nietzsche and Soviet Culture: Ally and Adversary, ed. Rosenthal, B.G., Cambridge, Cambridge University Press, (1994) p367. 2 FTC: p113. 3 Hirschop, K., ‘A response to the Forum on Mikhail Bakhtin’, in Bakhtin: Essays and Dialogues on His Work, ed. Morson, G.S., Chicago, University of Chicago Press, (1986) p75. 4 see Ware, T., The Orthodox Church, Harmondsworth, Penguin, (1983) for the most accessible introduction to Orthodox thought. 5 Clark, K. and Holquist, M., Mikhail Bakhtin, Cambridge, MA., Harvard University Press, (1994) p123. 6 Taylor, C., The Ethics ofAuthenticity, Cambridge, MA., Harvard University Press, (1991) p3. 7 RAHW: p18. 8 Stam, R., Subversive Pleasures: Bakhtin, Cultural Criticism and Film, Baltimore, Johns Hopkins University Press, (1989). 9 see Assad, M.L., ‘Michel Serres: In Search of a Tropography’, in Chaos and Disorder: Complex Dynamics in Literature and Science, ed. Hayles, N.K., Chicago, University of Chicago Press, ( 1991 ). 10 EN: p20. 11 RAHW: p24. l2 SG: p97. 13 DiN: p272 l4 ibid: p276. 15 TRDB: p293. 16 DiN: p292. 17 EN: p24. 18 Harrison, P.J., ‘General Psychopathology: Karl Jaspers, A Trainee’s View’, in British Journal of Psychiatry, Vol. 159, (1991) pp300-3. 1

Introduction

19

White, A,, Carnival, Hysteria and Writing: Collected Essays and Autobiography, London, Clarendon Press, (1993). 20 Jaspers, K., General Psychopathology, Manchester, Manchester University Press, (1963). First published in German in 1913. The 1963 edition was the first English translation. 21 Shepherd, M., ‘Karl Jaspers: General Psychopathology’, in British Journal ofPsychiatry, Vol. 141, (1982) pp310-12. 22 Jenner, F.A., Moneiro, A.C. and Vlissides, D., ‘The Negative Effects on Psychiatry of Karl Jaspers’ Development of Verstehen’, in Journal ofthe British Society for Phenomenology, Vol. 17, No. 1, (1986) pp52-71. 23 Clare, A,, Psychiatry in Dissent, London, Tavistock, (1980) p78. 24 Psychopathology, as developed by Jaspers, is loosely defined as the description and classification ofabnormal mental states. 25 Spitzer, M., ‘Psychiatry, Philosophy, and the Problem of Description’, in Psychopathology and Philosophy, eds. Spitzer, M., Uchlein, F. and Oepen, G., Berlin, Springer-Verlag, (I 988) p6. 26 Jaspers, K., ‘Philosophical Autobiography’, in The Philosophy of Karl Jaspers, ed. Schilpp, P.A., Illinois, Open Court Publishing Company, (1957) p17. 27 Ibid: pl8. 28 Kraupl-Taylor, F., Psychopathology, London, Heineman, (1979). 29 Understanding is a barely adequate translation of Verstehen which gathers its meaning from the qualities of comprehension, understanding and intuition. 30 Jaspers, General Psychopathology, p797. 31 Ibid; p8 19-20. 32 Ibid: p8 14. 33 Jaspers, K., ‘The Phenomenological Approach in Psychopathology’ in British Journal of Psychiatry, Vol. 114, (1968) p1313. First published in German in 1912. 34 Jaspers, K., General Psychopathology, p305. 35 Ibid: p829. 36 Ibid: p804. 37 Ibid: p79 I. 38 Gordon, P., ‘Private practice, public life: is a psychoanalytical politics possible?’ in Free Associations, Vol. 5, Part 3 (No. 35), (1995) pp275-88. 39 SG: p16. 19

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Chapter One

The Chronotope

[A] Quaker engineer had gone from Britain to Russia at the time of Tsar Alexander 1 [...] A group of peasants was sent to his house with an urgent message, knocked on the door, got no response, and went inside to look for the engineer. [. . .] Once inside, one's first duty as an Orthodox Christian is to find an icon [...] and say a few prayers, but this proved difficult. Nothing looked like an icon. What would a British icon look like? What impressed them most was the mantelpiece clock. They decided this was a British icon and so they crossed themselves, bowed before the clock, and recited their prayers. In a way the peasants were right. They had identified a machine which has immense power in the lives of “advanced ”people. Jim Forest1 As the multiplicity of voices suggests the possibility of many different I’s, so chronotopes2 suggest the possibility of many different nows. If we are all carriers of social voices then we are all equally a part of a mass of interweaving presentnesses. Space and time, like our own voices, are social products and different groups of people manufacture qualitatively different concepts of timespace. Bakhtin was long considered by his peers as being ‘out of step with his age,3 so it is perhaps natural that he was critical of a modem temporality that had plundered time from its ancient subjective origins. Modem time, with its uniform durations of measurement, has become so ingrained within us that it is difficult to imagine time that does not move in a one-way motion from the past through the present and on to the future. Bakhtin expresses a 21

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Language For Those Who Have Nothing

general scepticism towards Newton’s mathematical time arguing that it was forged by the needs of a scientism that had ruthlessly brushed aside the significance of cyclical or rhythmic temporalities. As an eager young student, Bakhtin had been impressed by Einstein’s theories of Relativity, and time, for Einstein, was anything but uniform. Relativity sees time as a highly flexible entity entirely dependent upon the subjective space of the one who was observing its movement. By relativising time Einstein had fused its movement with space. Time was shown to bend or expand as space was seen to shrink or distort. In Relativity Bakhtin saw a return of time to its old subjectivity and his chronotope blended time and space into a critical platform of analysis. He followed Einstein’s inseparable bonding of time and space but he anchored the chronotope in bodily form: Time, as it were, thickens, takes on flesh, becomes artistically visible, space becomes charged and responsive to the movements of time, plot and history.4 By giving flesh to the chronotope Bakhtin added in a further sense of uniqueness to the reading of the social voice. It is people who populate the timespace we all live within and it is therefore people who suggest the specific co-ordinates that shape every encounter. Even at the most basic level of standing it is evident that each and every one of us embodies a unique positional timespace: For only I – the-one-and-only-I – occupy in a given set of circumstances this particular place at this particular time, all other human beings are situated outside me.5 From here the chronotope is given its social form by adding flesh to the way gatherings of people organise themselves around particular sets of timespace. In the chronotope we have an idea of social world that is already there, replete with its own wisdom and its words already used, a community that is given new life by fresh encounters. Therefore to be a participant in a community it is necessary for the individual to be enfleshed by the same spatio-temporal dimensions that generate and shape its space. Participation is achieved only by entering into the stream of consciousness that is already flowing with meaning. The chronotope, Bakhtin tells us, makes ‘narrative events concrete, makes them take on flesh, causes blood to flow in their veins.’6 By constantly weaving timespace into a narrative the chronotope structures the way in which voices are given meaning and their sense of plausibility. As I develop the chronotope it will be seen to challenge the temporal assumptions of what Bakhtin calls the ‘horizontal time’ of the past-to-

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present-to-future arrangements of official time. Every voice is situated within a specific timespace and the possibility of dialogue is governed by the interaction permitted by different chronotopes. Most dominant chronotopes see no need of dialogue with lesser chronotopes but where dialogue is unavoidable they are content to impose a modified form of their own upon the other. Chronotopes, as we shall see, have different directions and purposes. They weave themselves through everyday events and give meaning to the way people enflesh time and enact the way spaces are used. Time, in the spatiality of the dentist’s chair or in a beneath-the-sheets intimacy, displays its own form of temporality. Both events are marked, in an acutely relative manner, by their subjective sense of duration. Chronotopes may be seen as mediators of human experience. Many co-exist with each other while others contradict or merely concur with stronger forms. Bakhtin is keen to locate the chronotope within his own dialogical formula: ‘The relationships themselves that exist among chronotopes cannot enter into any of the relationships contained within chronotopes.’7 Bakhtin here is malting an important observation for the psychiatric landscape. An observation that favours dialogue over empathy and one that encourages participants to build upon an encounter rather than seeking to uncover its history. My task at this stage is to identify the two principle timespaces that populate this landscape. The more obvious one I will call the Care Chronotope. This is a highly visible construct made up by a variety of practitioners and official spaces. The other, and much more inexact, I shall call the Patient Chronotope.

THE CARE CHRONOTOPE Historically, the Care Chronotope has been formed by gathering together several disciplinary bodies. Each voice in this chronotope carries its own wisdom and its own specific ways of relating to others. Every utterance contains the traces of a living relationship of the past to the future as well as the pace of its present time. Even the topography of its heritage can be detected in this voice. All of these embodied markers make possible the narratives created by the people who manage this landscape. In chronotopic terms, psychiatry’s vision is a vision always addressed to the future. And the future is one that is idealised and expressed positively. It is driven by the assumption that some day the resolution of abnormal distress will be achieved by proper methods of management ably assisted by the sufficient endurance of nurture and care. This vision commits the Care Chronotope towards schemes of practice that are projected onto a positively

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anticipated horizon. A future that is guided by systems of graduated improvements designed to heal the inadequacies of the past and justify all the anomalies of the present. Support for my premise is won from Andrew Scull who argues tha t the va lue of officia l psychia tric history lies only ‘to provide a supply of images of a barbarous past to illustrate the enlightenment of the present.’8 The dubious activities of psychiatry’s past are transformed into ideologies of progress with the present identified with all that is progressive and all that is negative is pronounced as outdated. However, the enduring faith in the yet-to-be-developed resolution of mental illness is a vision nourished by a misdirected energy. Narratives that fill the Care Chronotope are weighted by intonations of ‘what is and what ought to be.’9 Utterances can be so pitched out of their living context that the potentials available to encounters are considerably weakened. On the official parts of the landscape large tracts of professional discourse are harnessed to this yetto-come dimension. And these voices drain and emasculate the future of its potential. The ‘temporal descriptions10 that identify these utterances may well disguise the evils of the past and the present but they also empty the future of its lifeblood. The complexities of ‘temporal description’ can be illustrated with an example from the current literature. Writing in the British Journal of Psychiatry, H.G. Morgan11 is concerned that some patients are not receiving proper assessment under the auspices of multidisciplinary management. He complains that a ‘letter addressed “Dear Team” does little to ensure the question of team leadership and ultimate clinical responsibility can appear to be decided in a way which reflects the attitudes of the personalities involved.’ The ‘temporal descriptions’ that make up Morgan’s utterance express a nostalgic desire for a time when certainties were imposed by a highly visible institutional regime. They also address themselves to the heroes and heroines who personified the same certainties. The Doctor’s frustrations about his present circumstances can be weighed against Bakhtin’s sense of ‘historical inversion.’12 His concerns about the order of his clinic are portrayed in past certainties yet are represented as something realisable in the future. The Care Chronotope is well practised in sifting through its horrific past in order to reclaim its figures of certainty. Every past hero or heroine can be called upon to rescue a current uncertainty. And each generation of practitioners is anxious to claim their own timespace as the one that will herald the onset of the awaited vision. Jeffrey Gellers studied the content of introductory speeches made at the American Psychiatric Association over a period of 150 years. His conclusions pinpoint the same ‘temporal descriptions’ that are geared towards the idealised future horizon:

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Commentators on the status of American psychiatry during the past quarter-century have frequently remarked that psychiatry has “come of age. “ [My] review of I50 years of the association’s presidents’ remarks indicates that the sense of “coming of age” is an experience that is often repeated in our history.13 In the time flow articulated by these voices the lost consensus of a great Enlightenment experiment can be tasted. The certainties that were embodied by psychiatry’s past heroes are brought to bear on present anxieties and are used to fuel further enthusiasms. But the tragic paradox of the Care Chronotope’s presentness is that barbarity must lie in the midst of its everyday practices. In the face of its own history it must be assumed that the Care Chronotope is always at the end of a terrible history. The distinguishing feature of the Care Chronotope is the sheer speed of its time flow. Time is always ahead of the events that unfold in the available space. No procedure or code of practice can ever hope to keep pace with the flow of time. No space is ever arrived at in which time is reconciled with administration. In this chronotope one event follows another but the events themselves are not necessarily contingent on what has passed before. Therapeutic enthusiasms – Continuous Narcosis, Therapeutic Communities, Pre-Frontal Lobotomies, Conmorbidity - periodically illuminate the landscape, glow briefly, then fade, their consequences politely forgotten. It would be wrong, however, to presume that the voices governed by this chronotope move at a uniform pace. The standing of a chronotope is fundamentally relational. The way the official landscape is segmented by days and weeks is dependent upon the relationships to other standings. Spatiality within the Care Chronotope is always tightly bounded. Space is tiered with exact points of entry and exit: meetings, consultations, duty times on and off, the tasks of administration, and day-to-day institutional routines. In these spaces voices can be heard that compete with each other’s values and sense of purpose. Specific spatio-temporal markers express the way these voices interact with patients: the treatment of physicians, the case work of social workers, the service provision of administrators or the physical activity of nursing practices. The symbol of time itself becomes a badge that indicates a level of importance. Who gives time, and to whom it is given is a principle component of a body’s standing in relation to others. The enfleshed nature of the Care Chronotope extends into all the spaces that the social body occupies. The stairways, the offices, the walls all make their contribution to the embodied imagery of a living landscape. Bakhtin wrote of the ‘castle chronotope’14 as a timespace ‘saturated through and through’ with all the historical traces of earlier dynasties, furnishings and traditions. Such traces ‘animate every corner of the castle’ and act as reminders of past events. The same relationship exists on our landscape.

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Present in every encounter is an animated physical structure that has been witness to a continual renewal of standings. The matter of where one sits and on what part of the landscape one occupies is a principle component of a body’s standing in relation to others. The old asylums displayed a clock tower to represent the most prestigious points of its architecture. Guarding the privileged entry point to the asylum the clock tower was symbolic of an ever-present pull towards a coherent unity of purpose. As a symbol of social order the clock tower represented official time and official space. Again, it would wrong to assume a uniformity of pace even within the official world. Time is relational and it must compete within the measured chimes of the asylum clock. A weekend in the space of the central nursing office is not the same weekend on the back stairway of ward 22. The timespace that is experienced at a quarter-to-five on a Saturday afternoon is quite different from that of ten o’clock on a Monday morning. Thin crab-paste sandwiches eaten at ward 22’s supper on a dismal Sunday evening would not be possible with boardroom tea and biscuits on a Thursday afternoon. Every event carries its own sense of time that will serve the purposes of the day. And everywhere the clock tower is there to prescribe and regulate the activities on the landscape: every hour and every day has its own slogan, it’s own vocabulary and its own points of emphasis.15 Nowadays, with the clock tower bulldozed to the ground, the clinic must display its own clock and attendant calendar. On prominent parts of the ward clocks are positioned above large orientation boards which announce the events of the day and the staff who are on duty. Less conspicuously, but equally valid, time is also measured out by the rhythms of the day-room television and the pop songs on the radio. Activities fill in certain parts of the day, meals make up others, and bedtimes act as closures on a day. A variety of relationships regulate official time and each one strives towards the elimination and deflection of everyday uncertainties. By constantly projecting a faith onto a future time the Care Chronotope cultivates a narrative that is capable of dealing with the inevitable disappointments of the present and the shame of the past. In sum, the alliance of different voices that make up this chronotope is one always geared to a future vision. Pledged to the belief that progress is to be achieved by dropping from practice those enthusiasms that an expanding knowledge proves to be obsolete these official voices are determined to arrive at a planned and systematic resolution. Institutional demands for certainty – expressed by the ambition to reconcile time with procedure – cannot help but generate an underlying anxiety. As one space is filled time has already moved on. No

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point will ever be arrived at where a procedure will be sufficient to contain the unexpectedness of a new encounter.

THE PATIENT CHRONOTOPE Any entry into this chronotope is coloured by biographical narratives of resistance, anxiety, betrayal, or even in the surrendering of concern. Indeed, the latter response – belle indifference – is perceived as a clinical symptom. After all, to be admitted onto this landscape should concern a body. By definition people always arrive here from other timespaces and the transition can be a turbulent and even dangerous undertaking. The most comfortable method of arrival is for the patient to quickly embody a new lease of human imagery, namely, a passive acceptance coupled to a sense of dependency and compliance. To achieve the passivity of this standing the patient must adequately fill-in the expectations of the Care Chronotope. His or her standing will enflesh them with certain perpetuating factors designed to hold them plausibly within an illness. Time, in the Patient Chronotope, has a much more unstable quality than that found in the Care Chronotope. It is given to sudden accelerations or alarming tangents and its direction can go backwards or downwards or simply revolve in endless repetition. But the form of time that most characterises this chronotope is the kind of time that has a slowed-down almost viscous quality to it. Time is gelled into a circular space whose ’temporal description’ is often expressed as going round in circles or just going on and on. Herein, voices can be recognised by utterances that talk about subjects rather than seeking a form of action. The divisions that mark public and private timespaces are more pronounced in this chronotope. In any patient voice there is a weakened addressivity towards a public relationship but a much stronger addressivity directed to the private voices of inner dialogue. The Patient Chronotope has its own relationship to physical structure. Frequently there is an intensely changed perception of everyday physical objects. Timespace can be fully immersed in acutely experienced relationships to inanimate items. Patients can grip onto armrests or clutch the edges of blankets for many hours. They can pace up and down in confined spaces. Some aspect of wallpaper or a broken cup can be stared at over extended periods of time. And even the physical structure that is supporting one’s standing appears as fragile or inadequate to its purpose. Polished floors contain pools of deep waters or the metal legs of tables bend dangerously. On every part of this living landscape there are official and

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unofficial relationships to otherness. Things are seen and things are not seen. Voices are heard and voices are not heard. This landscape can be a dangerous space and the question of human proximity takes on a new level of importance. The patient’s previous linear understanding of time has been abandoned and replaced by the reality of a circular sense of time. To be entered into the downward narrative of this temporal direction is a solitary and intense experience. Such are the spiralling and circular eddies of this timespace that they come to produce their own encounters. Occasionally, and in small sheltered spaces, weary inner dialogues are invited to harmonise themselves with an on-going public voice. For the traveller and the patient alike these surprising spaces are to be discovered and engaged with if only because they mark the reintegrating connection between the downward and upward movements of circular time. In these unnoticed pockets of dialogue narratives are made possible and new experiences can be rehearsed, performed and tested-out. Here, spaces can be opened and different forms of narratives attempted. We shall see that beneath the faltering public face of mental illness is a voice whose wisdom is protected by the ancient carnival traditions of parody, inversion and folkbelief systems of understanding. If all these temporal descriptions of circular, downward and upward time appear too generalised then it serves to illustrate the nature of a chronotope that is not governed by closure or a graduated system of development. The traveller on this landscape become acquainted with time that moves in different directions and learns to be at ease with spaces that can conjure up quite unexpected encounters.

WHOSE TIME IS IT AND TO WHOM DOES IT BELONG? ‘As a general rule I wouldprobably have discharged her at the end of the week, or at the end of next week, but all the people I want to discharge will have to wait ... ’till I get round to doing all the notes.’ P.A. Morrall16 Although I will discuss in the next chapter Bakhtin’s idea of language as set within an official and unofficial tension there is value in applying the same structure to timespace. Official and unofficial language refers to an interdependent tension in which the powerful gravitational pull of a dominant language establishes, against all other lesser voices, a unitary status for itself. The feature of any unitary language is the ability to

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maintain a prominent standing and to have the authority to declare its own voice as official. From this position a unitary language can determine the standing of all other voices. The idea that timespace can be understood in the same manner is a compelling one. To have the power to manage the timespace of others is an important way of maintaining one’s own dominant standing. Elias Canetti’s commentaries on the ways political structures establish themselves carry a strong resonance with Bakhtin’s models of language. Canetti contends that it is a priority for any new regime to appropriate and control the regulation of time: ‘A new power which wants to assert itself must also enforce a new chronology; it must make it seem as though time had begun with it.’17 We can see this practice in progress on the psychiatric landscape. Each new generation that ‘comes of age’ begins by proving itself with a determination to regulate a new system of timespace. New administrative procedures follow in the wake of therapeutic discoveries in that they too announce the reorganisation of timespace. Previous or competing arrangements are assigned to the margins of influence and the need for dialogue with them is no longer deemed as necessary. The traveller must not only be mindful of whose voice is speaking but also of whose time is being used and to whom does it belong to.

IMPOSED TIME Modelled upon its own values the Care Chronotope imposes upon its patients a timespace designed to appear as neutral or harmless. Practitioners, particularly nurses, are often willing to lend out aspects of their own personalities to their patients. They hold their own standing as sufficient to absorb the pain of unexpectedness and to neutralise its threat. A linear belief in rest and a staged rehabilitation can be heard in this voice and nurses justify the practice by arguing that patients can only be exposed to a certain level of stress. The traveller takes an interest in these conflicts between different systems of timespace. Every time these values make contact with each other it will be striking how different chronotopes shape the way the encounter is contested. And the key to the contest is always to be found in the ‘temporal description’ of the utterance. For example, two screening questions commonly found in the clinical interview – “Tell me how things are going?” and “And how was your weekend?” – are immediately descriptive of a particular system of temporal value. The more linear perception of timespace (the way things go) and spatial concepts such as the weekend (the way working weeks go) take on their own distinctive way of understanding the encounter. It is true that clinical utterances do not always reveal their temporal direction so clearly but it is safe to assume that the

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guiding chronotope determines in advance the possibilities and limitations of every encounter. On the psychiatric landscape clinical time is accorded a higher value than lay time. Therapeutic arrangements of time work from the principle that everyone benefits from similar forms of treatment and from the same distribution of time. The traveller need not look far to see how clinical time protects its standing by importing classical and scientific terminology into its vocabulary. For example, medication is first prescribed by abstract notions of time, then extended into a classical form, and then crudely abbreviated into a formulaic code. Examples abound on every ward: – – – –

b. d. bis die t. d. s. ter die sumendus o. n. omni nocte q. d. quarter die

twice a day three times a day every night four time a day

The superiority of clinical timespace can be tracked throughout the official literature. Examples can be seen in the troubled topic of medication compliance and its attendant sub-texts of passive obedience or wilful disregard. In a paper typical of this genre Myers and Branthwaite18 studied 89 patients diagnosed with a primary or secondary depression. They carefully interviewed the patients at three-weekly intervals and at the same time they counted, recorded, and issued, the prescribed tablets. Over twelve weeks 20% of patients failed in some significant way to comply with the treatment regime and a further 18% did not complete the full course. Myers and Branthwaite conclude that inadequate compliance is important cause of ineffective pharmocotherapy and they make a plea that more attention should be given to the monitoring of compliance. Like many similar research papers in this field Myers and Branthwaite have little to say that is new or unexpected. And as long as practitioners remain reliant upon timespace working as a neutral entity and uniform to every voice research conclusions are unlikely to differ. Medication compliance can go wrong in other ways. Clinical time, so often governed by the measured beats of the asylum clock, can show itself to be deaf to the values of other timespaces. By way of example here is part of a chronic schizophrenic's dialogue: Er, because er, I have had an injection for er schizophrenia, er you know Depixol and it should he every 3 weeks but with – when after a while, after so many years you get to know when you actually need it personally, and I know about I7 days is the right length oftime. And they couldn’tfit me in at the hospitalfor that exact period oftime as it was too much messing about.19

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The formula repeats itself. Because clinical time must protect and maintain its standing it must seek to disconnect itself from lesser forms of temporal organisation. By insisting upon a single linear arrangement of timespace any potential arising from an encounter is muted or quickly closed-off. But it should not be forgotten that in every encounter between the Care and the Patient Chronotope an important activity is always in process. It is an activity created by the interdependency of the two chronotopes. One cannot exist without the other. The most symbolic aspect of this activity can be seen in the Care Chronotope's physical movements associated with immediate task's-in-hand. The passivity and dependence of the Patient Chronotope reciprocally mirror these enhanced movements. Right across this landscape the body is on display to the other. Both chronotopes act out narratives that are forcibly implicated in each other.

Forest, J. Praying with Icons, Maryknoll, New York, Orbis Books, (1997) pp35-6. Bakhtin's chronotope is made up from the Greek chronos, meaning time, and topos, meaningspace. 3 Clark. K. and Holquist, M., Mikhail Bakhtin, Cambridge, MA., Harvard University Press. 4 FTC: p84. 5 AA: p23. 6 FTC: p250. 7 Ibid: p252. 8 Scull, A., Social Order/Mental Disorder, London, Routledge, (1989) p6. 9 TPA: p20. 10 SG: p11 11 Morgan, H.G., 'Suicide Prevention: Hazards on the Fast Lane to Community Care', in British Journal of Psychology, Vol.160, (1992) pp149-53. 12 FTC: p147. 13 Geller, J.L.. Issues in American Psychiatry Reflected in the Remarks of APA Presidents: 1844-1904', in Hospital and Community Psychiatry, Vol. 45, No. 10 (1994) pp993-1004. 14 FTC: pp245-6. 15 DiN: p263. 16 Morrall, P.A., 'Clinical autonomy and the community psychiatric nurse', in Mental Health Nursing, Vol. 15, No.2, (1995) pp16-19. 17 Canetti, E., Crowds and Power, Harmondsworth, Penguin, (1973). 18 Myers, E.D. and Branthwaite, A., 'Outpatient Compliance with Antidepressant Medication’, in British Journal of Psychiatry, Vol. 160, (1 992) pp83-6. 19 Gibson, D., 'Time for clients: temporal aspects of community psychiatric nursing', in Journal of Advanced Nursing Vol. 20, (1994) pp110- 16. 1

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Chapter Two

I Need to Know Where I Stand The Official Languages of the Care Chronotope

I would define the claim to theory in the humanities as impatience systematized. Out ofJudaism grown impatient at the everlasting delay of the messianic came strange fruit. George Steiner1 The Care and the Patient Chronotopes provide the traveller with a novel set of co-ordinates. Once it is accepted that timespace is different across different genres then the potentials for dialogue are immediately changed if not enhanced. My task now must be to explore further the voices that live and breathe within these chronotopes. To do this it will be necessary to consider Bakhtin’s view of language as a social dynamic with the living utterance as its basic unit. This chapter lays the ground for my later journeys where it will be necessary to step down into Material Bodily regions of meaning. I will begin by outlining Bakhtin’s sense of official language and illustrate its complexities with examples drawn from current psychiatric literature. Bakhtin (or more accurately, the Bakhtin School) inaugurated a theory of language that ran on radically different lines from the theories being put forward in early twentieth-century Russia. The School’s clearest exposition of official language can be found in Marxism and the Philosophy ofLanguage a book authored by V. N. Volosinov, but later claimed by Bakhtin to be a work of his own.2 Volosinov’s work is perhaps the most forceful challenge to Saussure’s systematic use of langue as the means of analysing language. Marxism and the Philosophy of Language objects to 33

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Saussure’s dismissal of parole as worthy of analysis. Everyday speech, Volosinov argues, is not to be understood from the ‘stable and autonomous’ abstractions that Saussure insisted upon. Instead speech must be seen as a social activity and language as a living exchange of voices. For the Bakhtin School – itself forged on exhausting and marathon-long dialogues – every single utterance takes place in its own unique context and is primed with the flavours of addressivity, intonation, and ideology. Into this socially specific wordworld the Bakhtin School added in a further critical ingredient: the way we use words, how we intonate and style them, is wholly dependent on the presence and the anticipated response of the other. To advocate language as a purely social phenomenon is an undeniably radical step. Language, for Bakhtin inseparable from its social context, is also a medium formed by a body in relationship to otherness. It is the voice and the way it constructs meaning in a living relationship to another that ties language entirely to the body. A body generates this activity through the basic linguistic unit of the utterance: the commencement and the ending of a social voice. This book may be seen as an utterance. So might Dear Team or the interjection Oh! or even the many gestures of body language. As a unique social act the utterance is not to be compared with the grammatical sentence. Sentences after all can be repeated but the utterance is unique. Utterances are better understood as expressions living in the shared territory between the self and another. Bakhtin pushes this idea to the extreme that the self loses its sense of being a fully contained individual. If language (and therefore meaning and identity) is so dependent upon activity with another then selfhood can no longer be considered as being contained by the clearcut boundary of the individual body. In effect the Bakhtin School upturned the conventional notions of the psyche: The subjective psyche is to be localised somewhere between the organism and the outside world, on the borderline separating these two spheres of reality3 By locating consciousness between people the Bakhtin School assigns to the psyche an ‘extraterritorial status.’4 Like the living words of a language the psyche is only possible within a relationship to another. Words, rather than arising solely from an individual’s inner creativity, are now radically repositioned as being “half-ours, half-someone else’s.”5 The idea that the consciousness of a body depends on the presence of others threatens the widely held assumption that the anatomical positioning of the brain within the head automatically accords with the site of consciousness. Even within silent inner thoughts, argues Volosinov, the individual is engaged in a dialogue with other voices. Of course the logical extension of this thinking means that any perceived unity of the individual is immediately problematic.

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The body is no longer a separate and unified dynamic but more an identifiable point amongst a mosaic of differing voices. Locked into unique social contexts the body is now entirely dependent upon a relationship to the otherness of its given landscape. It follows on from this that language can no more escape from its social or bodily context than consciousness can act other than as a voice-carrier to the genre that propels it along. The way the standing of bodies are encountered on this landscape must now be assessed by quite different approaches. As a traveller intent on stepping down into this landscape I will discover how some bodies lend themselves well to particular voices. I will meet other bodies who engrave particular voices upon themselves in order to achieve a specific standing. Bodies are well capable of loaning themselves to standings that represent clear and recognisable social values. At this point I must be forgiven for seeming to fit Bakhtin into some abstract form of post-structuralism. This is not my intention. What separates Bakhtin from the more paranoid brands of modern hermeneutics is his own extended dialogue with Orthodoxy. Throughout his writings the influence of Orthodox teachings reveal itself. For instance, Bakhtin insists that each individual assume a personal responsibility in the context of every encounter. To be a unique participant in an unrepeatable dialogue means that the individual must take on the responsibility of a given response. An authentic life, one that is lived and engaged with, is not to be gained solely by abstract values but by an interactive dialogue with real people set within real encounters. At the heart of every Orthodox liturgy is the sense that the words uttered are expressed through sight, sound and smell. The very act of prayer itself becomes transferred from the abstract head to the living heart. In this way spiritual selfhood is positioned in the body as a whole. Prayer is much more than an intellectual exercise because it is offered by the whole body and, eventually, becomes indistinguishable from bodily expression. The theologian, Timothy Ware eloquently captures the representation of the Orthodox word through the body: “lips, intellect, emotions, will, and body. The prayer fills the whole consciousness and no longer has to be forced out, but says itself.”6 Bakhtin says more or less the same thing: To live means to participate in dialogue: to ask questions, to heed, to respond, to agree, and so forth. In this dialogue a person participates wholly and throughout his whole life: with his eyes, lips, hands, soul, spirit, with his whole body and deeds.7 Any standing on a landscape means that the body must invest itself in dialogue with another. Words only become real when they are pitched through living bodies and projected out into the social context. Accordingly, words and their meanings cannot be portrayed as passive concepts. Perhaps

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it is more useful to see words in the process of being rescued from the graveyards of dictionaries and then given life by being refracted through the body: ‘the word does not enter the utterance from a dictionary,’ reminds Bakhtin, ‘but from life, from utterance to utterance.’8 All words contain specific senses of time. Each act of speech carries both the history of its previous usage and the anticipation of the word’s contextual pitch. Because all words respond to previous utterances as well as anticipating a future response they may be seen as connective links in a social discourse. Michael Holquist has correctly observed that there are no ‘original’ utterances. Every ‘utterance is always an answer’9 to another utterance. And words, passed through the accents the body, are given a new contextual meaning every time they are used. Every time a body decides to borrow a word they are merely picking up on the taste of already used signs and symbols. In this regard words are made uniquely specific to an unrepeatable context. David Danow, in his intriguing account of Bakhtinian language, is attentive to the temporal aspect of words: Every word is by definition permeated with the past meanings and intentions of others – with inhering specific contextual, emotional, historical, or biographical overtones, which are immanent in the word prior to the speakers usage, itself implying at least in part a new set of intentions appropriate to the particular context at hand.10 To summarise so far, Bakhtin’s idea of language, refracted through the living body, is to realise its meaning only in the context of a social dimension. Human consciousness is set amidst a ragbag of competing voices that must call upon the accumulating wisdom of different genres. In every encounter the individual assesses the appropriateness of a genre and risks the intention of their words as they are pitched into ‘a dialogically agitated and tension-filled environment of alien words, value judgements and accents.’11 Here, in this most turbulent domain, words struggle and compete to win recognition. For dialogism to prosper there must be at least two consciousnesses in dialogue because meaning can only to be achieved by the aid of another. Such are the austere conditions of interdependency set out by the principles of dialogism. Bakhtin’s life work was devoted to understanding how the interaction (and responsibilities) of differing voices manifest themselves.

THE OFFICIAL VOICE To develop dialogism further and to understand how social tensions come to bend and stretch language it is necessary to return to the influence of

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Nietzsche on Bakhtin. I can best do this by making a creative connection and use the thinking of Michel Foucault as an explanatory intermediary.12 If we take Bakhtin’s socio-linguistic tensions and marry them to Foucault’s ideas of continuity and discontinuity, we can, very broadly, reach a common point of reference in the notion of Foucault’s event. Events, for Foucault, embraced the turbulent utterances and practices that occurred during those historically uncertain epistemic breaks that separate the more ordered periods of social life from each other. Foucault’s own history of psychiatry directly cha llenged the received view of a progressive a nd linea r development of psychiatry. His history broke up an otherwise continuous stream of progress with sudden and dramatic events. In Madness and Civilisation13 Foucault argued that those disciplinary structures which hitherto had carried true ways of seeing and speaking – Bakhtin’s “one language of truth”14 – were suddenly upturned by a particular event and replaced by a new structure that carried with it the prestige of a new discourse and knowledge. Almost immediately it was no longer possible to use the words that once governed the displaced structure. Bakhtin, himself schooled amidst the violent spectacles of revolutionary Leningrad, had considerable day-to-day experience of sudden events. It was from these times that he proposed that the ‘inner dialectic quality’15 of words were revealed only during periods of crisis. Dominant groups, arising from sudden epistemic events, will always seek to impose a singular, external character to their words. And in the aftermath of unsettling events words are easily made monologic. They become unconcerned with the response of the other and stripped of their essential dialogical quality. The remaining voices that still offer serious competition to the new dominant language find themselves displaced and pushed out to the peripheries by a new structure keen to demonstrate its powers. Foucault reinterpreted Nietzsche’s concept of the Entstehongsherd - the ever-present space open to occupation by various emerging forces - as an opportunistic space (for Bakhtin it would be a posited space) whereby various forces engage in the endless play of one dominant force overcoming another. In Nietzsche, Geneology, History16 Fouca ult la ys out the characteristics of these much fought over spaces. Occupation is won by the emergence of forces arriving from the peripheries and entering into the new dominant position – ‘the leap from the wings to centre stage.’ The new occupants of the Entstehongherd are now in a position to replace and define new legal and ethical values. A new status is displayed that conforms to the needs of power and privilege. Rapidly following in the wake of the new regime is a high degree of ideological uniformity that engraves itself onto the body and the voice of its adherents. Accordingly, this new cluster of

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bodies, confirms its own durability, and is well protected to ward off any future struggles against outsiders. Clearly, there are creative parallels that Bakhtin and Foucault derive from Neitzsche. The difference in emphasis is Bakhtin’s conviction that linguistic forces, and those who employ them, are interdependent upon each other. Each voice, consciously or otherwise, indelibly embraces the other. In a dialogical sense, one voice would have little meaning without the addressivity of another. For Bakhtin, the space of the Entstehongsherd is a space occupied by a self-styled centripetal linguistic force. A unitary force surrounded by a stratified medley of other centrifugal voices. But so powerful is the pulse of the centripetal language that its presence is felt throughout all sections of society. An example of this power can be illustrated in the unitary language’s capability of discounting the voices it finds itself surrounded by. A centripetal language carries the authority to ‘impose limits’17 on the centrifugal languages fated to orbit around this dominant nucleus. It possesses a monologic voice that has little need to enter into dialogue with any language other than its own. ‘Official knowledge,’ observed Allon White, ‘encoded in high language constitutes itself over against low language and unofficial knowledge by excluding the latter from its sovereign realm.’18 Yet, as Bakhtin continually reminds us, the tensions that connect the centripetal to the centrifugal must always be respected. As I come to step-down onto the psychiatric landscape I will meet this dependency as an everyday activity. However monological or absolute a discourse chooses to present itself there are always other powerful forces at work ensuring that the two extremes are ultimately dependent upon each other. At this stage it is enough to recognise how individual standings on this landscape are calibrated. It takes a particular kind of energy to enter into the gravitational pull of the centripetal. And one gains this energy only at the expense of kicking-off from the power of centrifugal forces. Those standings that appear the most secure are those that have been the most successful at abandoning the values of the forces they have pushed so hard against. By radiating a palpable belief in the safety of its surroundings the unitary language is in a strong position to attract other bodies to its embrace. New adherents must learn to maintain a stance skilled in exclusion and capable of patrolling its boundaries over an extended period of time. This centripetal world is the world of official knowledge and official language. We need not stray too far into the Care Chronotope before we find examples of exclusion and the stratification of other voices. Here is Manfred Spitzer, himself a successor to Karl Jaspers’s Chair of Psychiatry at Heidelberg, anxious to distance ‘armchair Psychiatry’ from the province of ‘real scientific theories’ of clinical practice:

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As psychiatrists, we are ‘informed ’ enough by the more intelligent paranoid patients and their ‘world systems’ on the relation between yin and yang, Hegal, chaos, quantum physics, Heraclitus, Chinese philosophy, or whatever – we do not need to publish these in our major journals (other than as case studies). Appropriate philosophical reasoning in psychiatry is clearly focused, based upon empirical clinical data, and aims at solving a particular circumscribed problem. It is not about the ‘essence of mankind’ or the ’essence of madness.’19 Spitzer strengthens the unitary value of psychiatry’s voice by discounting in advance the potentials available to dialogue with Chinese philosophers. Psychiatry is frequently threatened by destabilising voices and Spitzer encourages practitioners to be vigilant in protecting the integrity of an official coherence. Loyalty to this institutional principal makes demands on the practitioner’s standing at every level of clinical encounter. According to Bakhtin’s formula the practitioner who wishes to secure and maintain their standing the practitioner must: ‘purge his work of speech diversity’ and be alert not to mistake ‘social overtones, which create the timbres of words, for irritating noises that it is his task to eliminate.’20 Such linguistic cleansing is accomplished only at the expense of restricting dialogue to the framework of the official voice. A further example is offered by Felix Post, a leading authority on clinical interviews: [T]here is a conflict when carrying out a clinical assessment. The psychiatrist wishes to comprehend the patient and his disorder in terms of his own conceptual, framework, whereas the patient and his ,friends have no theoretical interests in the matter, but solely want help, and may pour out much that seems irrelevant21 For the practitioner the attractions of gaining admission to the centripetal regions of this language are self-evident. Guaranteed by every unitary language is the widest possible realm of mutual understanding. To stand in this ‘firm, stable linguistic nucleus’22 is to occupy a reassuringly strong position among the chaotic clamour of everyday life. Here the unitary language directly addresses the problem of giving order and management to the impact of irrational thought. As well as giving form to an individual standing the language of the Care Chronotope provides the individual with the means of projecting themselves into the network of professional relationship. The unity of the language becomes the unity of the discipline and, therefore, is responsible for where bodies stand and where they are positioned. A discipline whose vision is always directed towards a future horizon must continually stress the ambition for a unified and regulated language. Within the orbit of the unitary language the message is constantly broadcast that only an enhanced effort at unification will hasten the arrival of

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a timespace when the disturbed voice will be truly understood. Jaspers, of course, is central to this tradition. The idea that dialogue must be cleansed of its distracting voices is seen in his ambition to introduce into the thinking of the practitioner a ‘new methodological consciousness.’ When he took up his position at Heidelberg’s Psychiatric Library in the first decade of this century Jaspers was scornful in dismissing the voices he found assembled before him: The inordinarily voluminous literature in psychiatry of more than a century proved to be largely so much unfounded chatter23 Jaspers’s determination to win a sense of unity is still representative of the voices closest to the official centres that govern the psychiatric landscape. The constant hunger for certainty is driven by the belief that only within the profile of an even more standardised language will it be possible to reveal the laws that underlie irrational belief systems. Again we need not stray too far to encounter the contemporary echoes of Jaspers’s ambition. Here are two eminent psychiatrists of the 1980’s: [W]e need an overall inclusive theoretical base, a unified theory [...]. Without such a theoretical approach, properly used, we are destined to remain theoretical partisans.24 A deplorable feature of clinical practice in mental hospitals is the lack of standardisation in collecting and recording information. This is a severe hindrance to clinical, research and administrative practice.25 More recently psychiatry has been forced to make an accommodation to the commercial models of management. Wider and more forceful systems of belief have been imported on to the landscape and the language of psychiatry has become linked to the commercial truths of the world. Market forces rightly argue that the forecasting and allocation of resources can only work from clearly assembled data and funding sources have begun to insist on the standardisation of language. Two recent consultative documents; The Health of the Nation for 1991 and 1993, are insistent in impressing upon mental health professions a demand for linguistic unity that is scarcely altered from the days of Karl Jaspers: [ T]here is ut present no straightforward and objective way of describing, aggregating or monitoring outcomes of care, nor any agreement on clear and readable measures which could confidently be used us proxies for outcome measures.26

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The principle obstacles to setting national targets for health and social ,functioning of mentally ill people are limitations of available data and inconsistencies in the use of instruments to measure functioning.27 Increasingly, various bodies on the landscape have been made to absorb the voice of commercial interests. Imported terms - accountability, audit, consumer choice, quality control – have had a consequential effect on the ways language is refracted through the body. Many of the new terms have become ideological weapons to shore-up the standing of a given body. This flavour is clearly evident in Creating a Common Profile for Mental Health whereby providers are instructed to ‘ensure local purchasing decisions are firmly based around clear objectives for health and health gain.’28 A more powerful and pervasive voice has seeped into the voice of professional discourse. Today a part of every professional utterance is addressed to this powerful financial standing. And there are no shortages of practitioners willing to demonstrate their allegiance: We [psychiatrists] are paid a fixed sum per month, irrespective of the individuals we see and how we treat them. Inevitably our paymaster wants valuefor money and a ‘tidy ’ administrative scheme29 Peter Huxley, using the same voice, updates the Jaspers’s call for tidiness, unity and clarity: Purchasers will expect providers to demonstrate that they have fulfilled their contractual obligations. Providers will need good quality information [they will] expect measurable gains to be achieved from one contract to the other30 The continuing import of the commercial voice onto the landscape carries specific consequences to the body. The old standing of heroes and heroines has been radically modified. Teamwork, now widely accepted as a way of working in psychiatry, is a system poached directly from commercial practices. Modem commercial interests generally hold that the increasing complexities of post-war industrial processes are beyond the control of any one individual. Teamwork carries the advantage that a greater variety of problems may be tackled when exposed to a greater variety of skills. The import of the commercial voice into mental health has seen a new breed of managers’ nudge the old medical superintendents away from the office suites below the asylum towers. Teams of professionals find themselves under continuous centripetal tension to yield to the ethos of the multidisciplinary group and accept the security that is offered. To survive single bodies have had to merge themselves into a new variant of the unitary language. New groups, clustered together in fashionable bodily poses of relaxation and informality, have quickly come to efface the primacy of

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heroic individuality and adopt the impersonal voice of team, committee. administrative, or procedural system. So powerful has been the impact of this new model of management that to take an individual stand is to take on a position of conflict. The old bodies of Matrons and Superintendents, deemed as self evidently effective only a couple of decades ago, are now openly derided. But it is not the case that heroes have simply disappeared from the landscape. It is more that their voice has been modified to meet the demands of the new consumer-friendly ethos. Those old displays of individual certainty have been muffled and re-directed by the voice of newly venerated narratives. The transformation of old heroic standings into the unity of multidisciplinarism is signalled in the new forms of official texts. Those famous psychiatric textbooks of yesteryear – Meyer-Gross, Henderson, Sim – have now surrendered their heroic identity to the anonymity of committee. The introduction to Diagnostic and Statistical Manual of Mental Disorders (DSM IV 1994) proudly emphasises it is the product of a ‘team effort [...] more than 1000 people (and numerous organisations)’31 having contributed to its preparation. The equally prestigious ICD10 (the 10th revision of the Classification of Mental and Behavioural Disorders, 1993) draws the reader’s attention to the ‘particular significance of the acknowledgement section [as] it bears witness to the very many individual experts and institutions worldwide who actively participated in the production.’32 Of course, it could be argued that such a gathering of voices is in fact a dialogical expression of understanding. Is it not true that in these manuals we have many voices contributing ideas and ideologies into the thinking of psychiatry? Unfortunately this is not the case. Firstly, all the voices that speak in these manuals voices are untroubled by the opportunities offered by dialogue with the Chinese philosophers that so alarmed Manfred Spitzer. And secondly. there are of course no voices representing madness in these volumes. Against these bodies who strive for progress within the contexts of their own settlements the advantages to be gained by polyphony issue directly from the alteration in the stance required of the traveller. Aware of, but not swayed by the pressures that stratify the standing of others, the traveller is conscious that the more stable standing of bodies are bolstered by the certainty of their languages. On this landscape the traveller is frequently made to realise that both the questions and the answers are framed in the same nucleus of meaning. They are uttered by bodies whose standing holds itself to be self-sufficient and is reluctant or even indifferent to enter into dialogue other than in its own frame of understanding. Bakhtin warns of the danger that such bodies become imprisoned by the confines of their own closely guarded genres. Yet the Care Chronotope is wily enough to protect

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itself from direct challenges to its own sense of certainty. A tradition remains within the Care Chronotope whereby practitioners are insulated against the consequences of failed dialogues. Prolonged contact with madness is always delegated to subordinate bodies. As a general rule it can be said that the closer a practitioner is to the gravitational centre of the language the less time is spent with the objects of their care. Establishing the characteristics of psychiatry’s official voice is a relatively straightforward exercise. To go on to argue that this same voice is interdependent upon lesser linguistic registers is to concur with Bakhtin’s observation that all language is ‘ideologically saturated. ’33 Bakhtin’s use of the term ideology is different from the more familiar connotation of being a set of belief systems whose ideas have become fixed in the social consciousness. For Bakhtin such an understanding of the term would be an ideology of the higher kind, one that is drawn from the established systems of art or science. We might term this more public spectrum an official ideology. Against this the Bakhtin School argued for an unofficial ideology, one more rooted in everyday experience and charging every act with meaning. Therefore before speech (both inner and outer) can be studied the ideology contained within the social contingency should be identified. At base unofficial ideology is made up of the haphazard thoughts that constantly permeate inner speech. They rarely advance into the social world tending to remain as isolated experiences within an individual. Towards the higher of ideology a more proactive sensitivity is encountered. Here emerging social ideas take on their recognisable shape and the influence of social systems can be seen in the sequences of response and reaction. At various levels of ideological tension the surrounding official ideologies are absorbed and responded to. And the body by socially calibrating variable levels of inner and outer ideologies becomes both the product and the producer of ideological practices. In the next chapter I will encounter the phenomena of Ringmasters: powerful ideological facilitators who populate the psychiatric landscape. Their primary task is to ensure that the relevant ideology is fused into the body. The more the word is charged with ideological ingredients then the more language is loaded with responsibility. By unhitching language away from theoretical structures and placing it firmly within social contexts is to view the use of language as the primary point of investigation. At risk of course is that such a project can easily lose itself in an infinite regress in meaning. But this is exactly Bakhtin’s point in situating consciousness within a social setting. Because all words must be spoken in a context unique to both speakers, each word becomes constructed by traces of ideology, addressivity and intention:

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Language For Those Who Have Nothing Each word [...] is a little arena for the clash and criss-crossing of differently orientated social accents. A word in the mouth of a particular individual person is a product of the living interaction of social forces.34

Earlier I referred to H. G. Morgan’s concern over letters that began with ‘Dear Team’ lessened the standing of clinical responsibility. ‘Dear Team’ as a salutation carries its own ideological direction. Quite plausible ideological intonations of derision, of pride, of membership or even of competition can be extracted from its use. The phrase struggles at different levels of official and unofficial ideology. Morgan’s anxiety is contained in the conflict between a disciplinary hierarchy and a nostalgia for lost certainties. Should we reveal the ideological accents of this phrase we become meshed in all the ideological tensions that make up the historical progress of the Care Chronotope. Herein lie all the residues of the struggles and appeasement’s that have been necessary to secure particular standings. The phrase ‘Dear Team’ carries all the ideological traces of wartime psychiatry, the accommodations made with commercialism, the influence of humanistic psychology, and the looming presence of scientific medicine. All of these historical encounters have left their taste in everyday utterances. Manfred Spitzer’s reluctance to engage a Chinese philosopher in debate illustrates the sheer difficulty in reconciling the effect dialogism has on high/low binaries. Spitzer’s form and style (no easy variables for the professional to discard) restrict his voice to a specific range of genres even when other dialects may prove to be more adequate to a dialogue. The practice of aligning oneself to this voice means that one’s body is pulled in to an orbit that demands unification and a pre-occupation with description, precision, and measurement. The temptation of course can be wholly compelling. There may well be no choice available. The ambition to apply logical control regimes onto non-linear human problems carries ideological side effects on those who must manage the system. But the polyphonic traveller may have to spend many hours in the day rooms and the lounges of psychiatric clinics. Here the times and spaces are very different from those in the ordered world. Those approaches that work by clarification and systematic forms of assessment, though easily conceived in formula, are difficult to carry into practice when things do not, of their own accord, move in a desired direction. Thankfully, the very messiness of human interaction is always ahead of what it may be classified into. No matter how flexible the official canon considers its systems of observation to be they can never accommodate the unpredictability of human encounter. On this landscape it will frequently be seen the huge gaps open between the planning and the execution of given procedures. Institutional logic is quick to transfer any resultant difficulty onto the correct interpretation of its own instruction. It is presumed that the grand plan can be failed only by a

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lack of application by subordinates who are unable to commit themselves fully to further unification. In the end it is no small wonder why practitioners choose to enflesh themselves with administrative tasks under the everyday pressures of circumstances or the duties of office. The psychiatric landscape can be a treacherous region. Powerful standings are hard won and often fought over. As a cautionary note is perhaps prudent to realise that there is much wisdom contained in the old institutional maxims. The most frequently uttered maxim is the one that flavours every relationship on this landscape: – a body needs to know where it stands.

1

Steiner, G., Real Presences, London, Faber and Faber, 1989 see Morson, G. S. and Emerson, C., Mikhail Bakhtin: Creation of a Prosaics, Stanford University Press, 1990, for an extended discussion of the "disputed texts." I prefer to remain amused by Bakhtin's claim and extend a mischievous nudge and a wink alongside Bakhtin rather than argue whose voice was whose. 3 MPL: p26 4 MPL: p39 5 DiN: p345 6 Ware, T.. The Orthodox Church, Harmondsworth, Penguin, (1 983) , p74 7 TRDB: p293 8 FM: p122 9 Holquist, M., Dialogism: Bakhtin and His World, London, Routledge, (1990) p60 10 Danow, D. K., The Thought of Mikhail Bakhtin: From Word to Culture, New York, St. Martin's Press. (199 1 ), p39 11 DiN: p276 l2 David Patterson [Literature and Spirit: essays on Bakhtin and His Contemporaries, Lexington, University Press of Kentucky, 1988] has drawn together Bakhtin and Foucault as thinkers who have interests in discourse and language and its relationship to power and ideology. I would also note their shared affinity for the extreme oddities of social life. 13 Foucault, M., Madness and Civilisation, London, Routledge, (1961) l4 DiN: p271 15 MPL: p23 16 Foucault, M., 'Nietzsche, Geneology, History', in The Foucault Reader, ed. Rabinow, P., Hainondsworth, Penguin. (1984) 17 DiN: p276 18 White, A,, 'The Dismal Sacred Word: Academic Language and the Social Reproduction of Seriousness' in Carnival, Hysteria and Writing: Collected Essays and Autobiography, Oxford, Clarendon Press, (1993). 19 Spitzer, M., 'Conceptual analysis of psychiatric languages and models of disease', in Current Opinion in Psychiatry, Vol. 4, (1991), pp763-8 20 DiN: p327 21 Post, F., 'The clinical assessment of mental disorders', in Handbook ofPsychiatry, Volume I, General Psychopathology, eds. Shepherd, M. and Zangwill, O.L., Cambridge, Cambridge University Press, (1983) p212 22 DiN: p271 2

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Jaspers, K., ‘Philosophical Autobiography’, in The Philosophy of Karl Jaspers, ed. Schilpp, P. A , , Illinois, Open Court Publishing Company, (1957), p16 24 Grinker, R. R., ‘Roy R. Grinker Sr.’ in Psychiatrists on Psychiatry, ed. Shepherd, M., Cambridge, Cambridge University Press, ( 1982) p33 25 Watt, D., ‘David Watt’ in Psychiatrists on Psychiatry, ed. Shepherd, M., Cambridge, Cambridge University Press, (1982) p197 26 HMSO., The Health of the Nation: A Consultative Document for Health in England, London, HMSO, (1991) p87 27 HMSO., The Health of the Nation: A Strategy for Health in England, London, HMSO. (1993) p86 28 HMSO., Creating a Common Profilefor Mental Health, London, HMSO., (1992) pg. iii 29 Crammer, J. L., ’25 years of the British Journal of Psychiatry’, in British Journal of Psychiatry, Vol. 153, (l988), p453 30 Huxley, P. J., ‘Systematic assessment procedures in psychiatric social work’, in Recent Advances in Clinical Psychiatry: Number Eight, ed. Granville-Grossman, K., Edinburgh, Churchill Livingstone, (1993) p152 31 DSM IV., Diagnostic and Statistical Manual ofMental Disorders, 4th edition, Washington, American Psychiatric Association, (1994) pg. xiii 32 ICD10., Classification ofMental and Behavioural Disorders, 10th Revision, Geneva, World Health Organisation, (1993) pg. vii 33 DiN: p271 34 MPL: p41 23

Chapter Three The Ringmaster and Laughter in the Care Chronotope

Humour is not for babes, Martians or congenital idiots. We share our humour with those who have shared our history and who understand our way of in terpreting experience. Walter Nash1 This chapter is the first in my descending order of step-downs onto the psychiatric landscape. Here I intend to travel with the object of encountering the unofficial genre of practitioner humour. I have already been advised by Bakhtin of the high degree of complicity between inner and outer narratives and I know that whatever low genre I come across will be characterised by motor connections to higher forms of discourse. There is no time where I can have one without the other. In this regard the Care Chronotope occupies a dual, Janus-faced, standing. The more obvious official voice faces outwards in a relationship to the public domain of everyday life. Another, quite different voice, faces towards more circumspect levels of meaning and reverberates with all the noises of the Material Bodily Sphere. The connection is an indirect one yet one substantially form-shaping to the standing of professional identity. But a warning is in order at this point. By purposely making practitioner humour visible I am treading on delicate material indeed. After all, what I seek is something that is normally excluded in order that an official propriety can be maintained. At risk in my encounter is that I embarrass, if not endanger, the borders that define the official body. Such bodies are unlikely to surrender lightly the more unflattering aspects of their oral traditions. 47

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Even before I commence my journey I realise that the opportunities available for a face-to-face investigation are considerably weakened, Practitioner humour produces a high content of hostility and accordingly there is a strong analytical defensiveness on the part of the practitioner. In order to deflect and distract the public face of psychiatry I must adopt an indirect means of encounter. I can meet this need by stepping-out and moving away from more approved means of inquiry. So it is here that I will make my first tentative connections with the creative ruses of cunning and deception. But before I can do this I need to do two things. Firstly, I want to add further flesh to the meaning I have given to polyphony, and secondly, I need to consider the role that anecdote plays in the Care Chronotope.

POLYPHONY The fundamental concepts of polyphony can be represented through the biographical time of Fyodor Doestoevsky. Bakhtin saw in Doestoevsky a man who created, from his own life experiences, the polyphonic novel. Dostoevsky’s many social and ideological shifts drew for Bakhtin the first of two essential components for polyphony: [H]e participated in the contradictory multi-leveledness of his own time: he changed camps, moved from one to another, and in this respect the planes existing in objective social llfe were for him stages along the path of his own life’2 Polyphony, as a creative activity requires regular and diverse radical changes to the author’s position.3 To think and act as a polyphonic traveller means to actively interfere with some of the concrete-bearing parts the bodily utterance. To move from one perspective to another involves the traveller in more than merely engaging in intellectual shifts. Polyphony means the body must be fully and consciously engaged in every utterance. I mean by this that the author, as a polyphonic traveller, is one who is identified by frequent shifts in their own centre of gravity. The radical changes to the more usual standings towards others immediately opens up a different range of possibilities. In this way polyphony equips the traveller to side step the more approved regimes of face-to-face encounter. Self evidently a changed authorial position will have a notable effect on a relationship to others. Clearly there are dishonourable opportunities available in the foregoing. Every rogue and charlatan would recognise the advantages to be obtained from a changed bodily utterance. Less I stray too far from ethical considerations, polyphony, as a strategy for exploration, must be linked to a

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further characteristic. For Bakhtin, Doestoevsky’s own life experiences gave him a deep appreciation of the contradictions that exist among all people. His genius in creating the polyhonic novel lay in his ability to think ‘not in thought but in points of view, consciousnesses, voice.’4 It seems a nonsensical statement to make yet Doestoevsky portrayed his characters as if they were independent of the author who created them. Polyphony perceives other people, like the characters of Dostoevsky’s novels, to be in a constant dialogue: ‘A plurality of independent and unmerged voices and The consciousnesses, a genuine polyphony of fully valid voices.’5 polyphonic worldview is one where the author is one voice among other voices. Bakhtin is not advocating polyphony as another strand of relativism because the author’s position is not one of a passive and detached spectator. The Polyphonic novel is always conscious of another’s standing and encourages encounters whereby characters can argue with the author who created them. Such relationships can only be achieved through the author’s ability to create a posture of being alongside or being-by another. So for the author, as well as the traveller, there is no sense of straining for triumph over another, no determination to prove a particular voice, no pursuit of some underlying system. The act of being alongside another enhances the potential that everyday events are experienced in the context of the moment. A useful analogy is to be found by extending the musical metaphor of polyphony. Polyphony’s opportunistic methodology can be more aligned to Jazz and its starting point in performance rather than classical composition which works from a gradual and planned development. In the following chapters I shall make periodic returns to add further flesh and blood to the concept of polyphony. At this stage it is sufficient for me to take on the polyphonic characteristics of a radically changed position. A traveller ambling alongside other independent consciousnesses.

ANECDOTES Polyphony is a typically Bakhtinian concept. It is a double-voiced notion loaded with oppositional meanings, expressed simultaneously, and bound to each other by dialogue. Polyphony is a reminder that the Care Chronotope works at many interconnecting levels rather than with any narrative unity. As an agency concerned with human interaction the Care Chronotope can be represented as an anecdotally-driven discipline. All its textbooks, journals and case conferences are awash with examples of human behaviour refracted through the wisdom of professional voices. Every professional encounter with the mentally ill generates observations that memorialise, by different forms of narrative, a guaranteed space in clinical management. A traveller

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will discover a variety of official and unofficial narrative forms. Official observational material is of course widely available. Examples abound: JC, a 30-year-old married woman, was admitted 12 days after the birth ofherfirst child. She had a two-day history of insomnia, overactivity and bizarre behaviour, particularly of an erotic nature. On admission she was disinhibited, elated, with pressure of speech, flight of ideas and delusions of grandeur of a religious nature. She also had the delusional belief that the admitting doctor was her brother-in-law, to whom she expressed her love, addressing him by this man’s Christian name. She also stated that she had informed her husband of “their affair.” She totally lacked insight into her illness. There was no evidence of cognitive impairment or depersonalisation. Her pre-morbid personality was that of a sociable and capable person with no past history of a family history of psychiatric illness. She was treated with chlorpromazine, but after an incident ofa sexual nature with a male patient, she was discharged at the insistence of her family. Follow-up was limited and when seen 24 months later she had only recently regained her pre-morbid level offunctioning, having become mildly depressed in the interim. Her diagnosis, based on Research Diagnostic Criteria, was that of manic-depressive psychosis. 6 This case history shares with narratives working at other levels of meaning the same monological characteristic of single-voiced authorial presence. The voices that appear – the woman, the male patient, the family – are muted and made passive in the telling; a technique of monological discourse that Bakhtin would describe as an ‘active double voiced discourse’7 The two authors of this case history have taken the voices of others and installed their own interpretation upon them forcing the anecdote to serve their own purposes. Whatever dialogue was available in the context of encounter has been reworked through voice of the two authors in order to meet the intention of a rationally successful closure. But to be fair to the authors of this case history they are required to frame their observations within an approved format. Case histories, like all narrative forms, contain their own structural characteristics. The reader senses the course of its narrative drive and is able to anticipate the sort of outcome it will have. Common to all case histories are a particular sequence of events. A pattern is revealed that formulates a recognisably approved account of clinical interaction. If case history can be seen as an utterance then our example is marked by a particular authorial addressivity.8 The author’s voice is directed specifically towards an absent, yet very present, higher-ranking authority. Their voice is committed towards the anticipated response of this authority and their style of format ensures both the validity and the continuation of the genre. As a typical case history it is a defensible

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account of the way mental illness is managed in late twentieth century psychiatry. It offers an adequate, if not exactly triumphant, closure to an explanation. Any time spent in a clinical environment will confirm that the dialogue of practitioner and patient encounter is available for dissemination through differing levels of meaning other than the official voice alone. The daily exchanges of anecdotes, whether at case conference or coffee breaks, involves psychiatry in an on-going and self-legitimising process. The Maintenance of this legitimacy is greatly aided by a mode of professional standing that deems such dialogue to be private or confidential. Following Bakhtin, I will argue that this integrity cannot be sustained without the aid of regular forays into the Material Bodily Sphere. No unitary language can maintain its coherence if it is continually exposed to levels of everyday dialogue. Bakhtin’s philosophy is alive with heroes, rouges, clowns, and grotesqueries. At the other extreme of the social scale his work also pays homage to agelasts, those characters who represent the dying part of a whole and experience the world through tightly closed-up apertures. Each one of these characters carries particular ways of relating to otherness. Indeed, some are temptingly seductive, only too willing to add spice to a rational world starved of enchantment. There are dangers of course in striking the two extremes on the same plane. The temptation to take up sides ignores the cloying characteristic of a living interconnectedness. In polyphonic activity we have the potential of collapsing the public and the private voices of psychiatry into each other. Unveiled before us is a landscape congested with competing meanings rather than one governed by a desperately sought after unitary voice.

METHOD A few years ago I was spending some time at Sheffield University trying to get a research application off the ground. I had heard that a group of senior medical students were about to begin their psychiatric block of study and it was a common practice that before being allocated to their wards the students underwent a two-week course of introductory lectures. To me this seemed a most interesting gathering. Here was a place where the public face of psychiatry must reveal sufficient amounts of its everyday practices to a group that are, after all, it’s potential recruits. And for their part the body of students is likely to be uncertain and anxious about encountering madness for the first time. The potential ofthese lectures held for me all the tensions associated with Bakhtin’s ‘threshold chronotope:’9 - the breaks in a

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biography that are shot through with alternating acts of boldness or anxiety. I could think of nowhere where I would be more likely to encounter the fertile pastures of practitioner humour. My presence in this space was suddenly important. I began my journey by knocking on the door of a lecturer I knew to have connections with the hospital. I put my case to him. I was very persuasive. He agreed to fax the facilitator of the course and recommend my attendance for the duration of the introductory fortnight. We agreed that my research interest was to be in comparative medieval psychiatry. As a ruse it was suitably non-threatening but it enabled me to avoid discussing with the tutor group and the students the true purpose of my presence. I felt it important to gather the material in an uninhibited context as possible. A stranger sitting in a classroom openly collating jokes and laughter is hardly conducive to its expression. There is a real methodological problem in plundering laughter from its communal settings. To present jokes in the light of a written text is to considerably weaken their contextual potency. Therefore the following classifications and rating scales are more an attempt to indicate a sense of feeling and activity within the lecture room. I have gathered together my material around three variables: a) the status of the anecdote, b) a scaled response to the anecdote, and c) the target or butt of the anecdote.

STATUS Humour in the form of jokes (all recorded jokes are numbered and appended with a ‘J’) is defined as an anecdote that seeks to provoke laughter in an audience. Quips (appended with a ‘Q’) are separated from jokes in that they work spontaneously but evoke a similar response. Each appendage includes a scaled response of audience laughter.

RESPONSE Jokes that earned no response are not recorded. Many of the jokes were skilfully embellished by the wit of the teller but I have reduced all joke narrative to a basic form. Each joke is annotated with a scaled audience response, assessed on a five-point scale: 1. an audible amused titter 2. definite laughter 3. majority laughing openly

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4. all laughing heartily 5. loud and protracted laughter

TARGETS Reducing the voice of a joke to its most basic form makes it easier to distinguish between the belief system driving the narrative from that of the joke's target or butt. My system of arranging jokes into four areas is inspired by Jerry Palmer's criteria that central to any understanding of humour is the identification of a target.10 G. Legman adds similar weighting to target recognition: ‘The most important element in understanding any joke is to grasp clearly and from the beginning who is the butt’.11 Such exact injunctions, however, must acknowledge humour's ambivalent structure. All humour carries a variety of motif overlap by which considerable meaning can be loaded into the shortest utterance. I must admit that at the beginning of my project I was anxious that these introductory lectures would fail to provide any humour. Suppose the genre of practitioner humour did not exist? And if it did would the humour be so scattered or innocent that any attempt at classification would be pointless? This was not to be the case. So obvious were the targets of humorous anecdote that a system of classification more or less self-assembled itself into four main clusters: – – – –

Students (numbers 01 – 052). Patients (053 – 082). Competing ideologies (083 – 093). Miscellaneous (094 – 0104).

(see Appendix 1 for all recorded jokes)

HUMOUR AND LAUGHTER – THE STUDENT CLUSTER The lectures were held in the large library of the hospital. In general they were poorly attended. I was present for 22 lectures and I felt the poor attendance accurately reflected the low opinion in which psychiatry is held among medicine. Only occasionally were their more than two dozen students present. Nonetheless, this was a sufficient number for me to sit alongside and unobtrusively make notes on all the jokes and laughter. One Monday morning in the summer of 1995 I arrived at the lecture room and nervously introduced myself to the co-ordinator. He welcomed me and invited me to join in on all the fortnight's activities. I soon found myself mingling with a large group of medical students around the coffee and

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biscuits. The atmosphere was charged with anxiety and anticipation. Listening in to the general conversation it was apparent there were three significant areas of tension among the group. These anxieties, to varying degrees, were to be an uneasy burden upon the students throughout the lectures. As the lectures got underway these anxieties found a communal expression. Firstly, an important examination – ‘Obs and Gyney’ – had only recently been completed and the results were to be posted at the end of the week. These results, and a variety of examinations, vivas, and allocations, were the constant topics of student conversation. The tutors, sensitive to this tension, often framed the anxiety into a teasing challenge. 038Q: Obs and Gyney? Ahh! Easy (2). 05Q: Vivas? Anyone not anxious about them? Either lying or there is something wrong with them (2). (see also 01 02 07 08 016 017 022 024 033 037 038 052). The second area of tension was in the uneasiness expressed concerning face-to-face contact with mad people. Significantly, the students’ concerns were voiced with an intonation of levity. Again, the tension found its echo in tutor humour: 051Q: Don’t allow someone who is suicidal to sit by an open window (2). 035Q: You won ’t be left alone. Don ’t worry (3). (03 014 034 042 047 051) The third area of anxiety were handouts; essential pieces of paper which summarised the contents of a lecture. For the student getting hold of one became a priority. If none were distributed at the beginning of a lecture – 023Q: There is a handout so you don ’t have to scribble this down (1) – then some indication was sought from the lecturer as to their availability. The anxiety surrounding handouts was an important one, for they represented the principle access to revision for those present and friends absent. Again, this anxiety was recognised in humour. 028Q: Don’t write anything down. I want you to think. There are handouts to be given out (1). (04 012 020 021 023 026 032 043). At one level classroom humour can be seen as the discharge of a collective tension. The group recognises a specific fear and its management is partly achieved by laughing at the anxiety itself. T.G.A. Nelson, in a classic work on comedy, suggests this theory of ‘psychic-release’ complements an age-old formula where humour begins with dangers and ends in the resolution of laughter.12 In the lecture room this aspect of humour was evident, if only because it was the principle means of framing such tensions. The students sometimes weighted their questions with levity as a way of testing out an unsettling area of clinical medicine. Alternatively, it can be said that humour, in this setting, is no more than a socially polite way of establishing a conducive rapport between the tutor and the student body. Humour, in the relaxed climate of our times, is generally

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considered to attract and hold attention. This assumed truism continues to encourage communicators to scatter their lectures with a variety of witticisms. Dolf Zillman,13 however, points to several studies questioning the popular idea that humour puts students at ease, enabling a better concentration and absorption of knowledge. Zillman’s observations support a premise that a gain in knowledge is not significantly enhanced by the funniness of examples. Indeed, in a system of medical education dependent upon a student’s capacity to absorb seemingly endless handouts of syndromes and symptoms, the assistance of humour, as an aid to learning, would seem questionable. Were the tutors to be asked to explain their use of humour their probable response would focus on interpersonal rapport or the softening of the harder edges of official knowledge. In this response Bakhtin recognises the modem world’s reduction of laughter’s power. Laughter, argues Bakhtin, has dramatically shifted its centre of meaning from the interpersonal to the intrapsychic. Once laughter was understood as a universal, essentially communal, philosophy: ‘one of the essential truths of the world as a whole [. . .] the world is seen anew, no less (and perhaps more) profoundly than when seen from the serious standpoint.’14 In the great medieval carnivals laughter carried all the complexities of laughter’s ancient ambiguities. The high ideals of the ordered world, cast down and degraded by carnival laughter, were understood as a positive gesture, a process leading to the renewal of a particular target. In modem times laughter has become weakened and is not always capable of returning its target to the wholeness of a new and restored reality. But however much laughter has become reduced it cannot be denied that aspects of an ancient laughter still survive in the modem world. Laughter is still capable of evoking a strong collective response in which few can escape: ‘The truth of laughter embraced and carried away everyone: nobody could resist it’15 In laughter’s embrace a body continues to respond to an ancient need for the safety of human proximity. Laughter’s transformative power works to mediate the values of the individual into the value of the group. Sat together in the lecture room laughter became the medium that reached out to everyone to offer a reassuring alliance. After all, the price paid by the individual for not laughing is a high one. Those that laugh express a sign of social acceptance and a shared knowledge. Those that fail to laugh place themselves in a lonely and defensive position. With their sudden beginnings and sudden endings jokes share a common temporal structure with the carnival. In both the joke and the carnival a temporary suspension of official values is permitted. Bakhtin saw the carnival as a ‘temporary liberation from the prevailing truth and from the established order; it [permits] the suspension of all hierarchical rank,

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privileges, norms, and prohibitions.’16 In a like manner, and sometimes with an almost effortless ease, a tutor could submit an official truth to the carnival powers of unexpectedness or inversion. A sudden raid could be made into an ever present Material Bodily Sphere that primed the carnival powers of outrageous surprise: 09Q: Last year’s group said it [a considerably more demanding appraisal] should be introduced (4). Equally, official systems of meaning could be suddenly inverted or reversed at will: 06J: Hallucinations happen to everyone every night. Might even happen to medical students during the day (1). I want to argue that the humour and laughter in the lecture rooms enabled a sharing of communication that wasn’t possible in the official voice. Humour offered a level of meaning where two or more ways of perceiving the world could be collapsed into each other. Here, in this clinical region I realised that humour and laughter must be seen as a collective force. It is a living dynamic that shapes an ideology in a way that the official voice would be reluctant to admit to.

HUMOUR AND LAUGHTER AS INITIATION At this point I can offer a more precise bearing on my position. Here in the lecture room I am witness to two quite different voices. At the centre is the voice of the tutor. A clear and a confident voice set against the assorted uncertainties of the student body. In each lecture and as each new subject matter is introduced I am aware of the delicate balance between official and unofficial ideologies. This is not to admit to a firm separation between the two. For often the student body is introduced to the subject by way of an outside narrative before it is presented as an inner dialogue. In fact a clear sense of complicity exists between the two dialogues. Consciously or otherwise, the tutor voice can frequently be seen foraging down in the disordered domains of the Material Bodily Sphere. One way of looking at this curious interdependence is to view the student body as initiates sitting on the outer orbits of proper descriptive speech. As a body they sit uneasily on the edge of the official voice in that deferential silence so familiar to all initiates. In Bakhtinian terms, the voices at work in this space can be formulated by two chronotopes. Firstly, and more obviously, the Threshold Chronotope17 embodies the full liminal state of the students. This is a chronotope rich in transitional moments of ‘crises and breaks’18 where time is abruptly segmented into changes marked by a sense of loss or the anxiety of a new beginning. Time is enfleshed as bodies fall in and fall out of differing accelerations of duration. Flesh is seen to ebb and flow between the thresholds of individual and participatory bodies. And as

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this voice gains and amplifies they become bodies who are both the product and producers of official practices. Almost all transition is unsettling to a bodily standing. Every movement from one body to another means the loosening of a familiar footing. Even the most positively anticipated of change is shadowed by an anxiety as the security of an otherwise habitual standing is abandoned. In Bakhtin’s Rabelaisian Chronotope19 we have a timespace always on hand to mediate the displacement of one body to another. Bakhtin built the chronotope from Rabelais’s wild and earthy narrative and argued that only the forces of the Material Bodily Sphere were powerful enough to drag an old medieval world view into the body of the new humanism. Rabelais intermixed every available voice into his writings. He submerged everything into a morass of Mother Earth and the concerns of the lower bodily strata in order that the old medieval body – ‘coarse, hawking, farting, yawning, spitting, hiccupping, noisily nose-blowing’20 – could be contrasted favourably against the new humanistic and harmonious body. Even today we still call upon the remnants of carnival practices to facilitate the absorption of one body into another. The sceptical need only spend a short time at a New Year party or a Stag Night celebration to confirm this observation. Bakhtin goes on to develop the principle characteristic of the Rabelaisian Chronotope in its potential for growth. Evident in Rabelais is the tendency to spread out everything that has value in order that it may achieve its fullest expansion. And certainly in the context of the lecture room all the values pertaining to psychiatry where being expanded and displayed by the genre of practitioner humour. Those values deemed as negative were stretched and contracted, juggled between inner and outer narratives and were made to ‘thin out and perish.’21 At the same time all those ties with older certainties, the ‘false connections, the false links’ were progressively untied and spread out before us all. Jokes have the power to make the familiar enter into a free union of unexpected connections and the ‘most surprising of logical links’22 It requires only the noise of collective laughter to confirm the task of silencing the old knowledge is complete. One of the most frequent values to be spread out before the student body was the lay or folk conception of psychiatry. The mysterious powers available to the adept’s gaze was constantly voiced in connections to the student body: 050Q; You are very quiet, very quiet as a year. We’ll do supportive therapy on you (3) (03 025 031 039 044 047 048 052). At one point a tutor put forward the suggestion that ‘embarrassing questions’ ought to be ‘acted out’ at a future session, adding: 03Q; Before you all decide not to come on Wednesday ..... (2). This quip is representative of the lay belief in the psychiatrist’s mysterious powers. It is a sustaining myth that links the powers of the psychiatrist’s gaze to be a part of the official

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voice itself. In many jokes the gaze of the tutor is a constant theme. This sacred thinking vision, available only to the adept practitioner, is displayed before the anxious student body both as a temptation and a warning. 039J; Stand in front of a mirror and look at yourself closely. You won ’t enjoy what you see. Those that do come back and I will treat you (2). In this complex statement the tutor uses the mystery of the heroic gaze to indicate that underlying forces are always at work beneath the most mundane of activities. He suggests that only the pure language of an adept’s thinking vision is capable of understanding these forces. So powerful is the mystery of the official voice that it is capable of silencing any other intrusive contenders: 044Q; Just smile and say you are doing psychiatry, It really unnerves them (2). The jokes are used to underscore the message that the power to act in the domain of the unknown requires the ability to see what others do not see. Again, the tutor spreads out this theme on the body of the assembled initiates. 025J: If I brought a Lion in here you ’d all jump out of the window. If I told you it was tame, with no fangs and no claws, you might stay but go and report me (3). Students are warned, tempted, and teased that the entry into the adept body is a long and arduous one. Humour is used to indicate that the route is very different one to that found among other students. 01 I Q; I am aware that medical students are not as involved in the student drug scene. Consequences of drug-taking are more than if you are studying English (2). (03 013 024 025 035 041 044 047 052). The threshold nature of the student’s position also finds itself spread out by humour: 02Q; By the time of qualification you have to do two years as House Officer. Sorry. One year. (2). The transfer of the heroic qualities of self-reliance and competence onto the initiate body involve some powerful shifts. Bakhtin was to use Henri Bergson’s observations on humour and its means of issuing a strong sense of social correctiveness. For Bergson humour and laughter were ways of guiding and shaping communal values: ‘Each particular profession impresses on its corporate members certain habits ofmind and peculiarities of character in which they resemble each other and also distinguish themselves from the rest ’23 It can be seen in the hostile contrasts that the tutors constantly display before the initiates the values that ‘resemble each other’ and those values that ‘distinguish from’: 047Q; It’s notjust have a cup of coffee, have a chat and say “there, there ” (2). Just occasionally the tutor uses humour’s ambivalence to lighten his frustration: 015Q: At this rate you might become a joint doctor. Come on. A person on the street can tell me this (I). The initiate’s laughter demonstrates their desire to deflect the tutor’s anger and

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interpret the utterance in a safer intonation. Humour’s ambivalence is also evidenced in that meaning can move in different directions in the same utterance. In this quip it can be seen both directing and deflecting the severity of personal criticism: 036Q: Very brave of you [a late student] to come in like this. Hardly worth coming (2). A body that conducts itself within the segmented crises of the Threshold Chronotope is considerably aided by the proximity of other initiates. Laughter symbolises a diminished danger and the domestication of an unfamiliar force. To be part of an initiate body that laughs is to rehearse the expansion of group confidence. Yet the student cluster of jokes only carried an ephemeral quality of humour. The power of these jokes was easily exhausted and sometimes melted away in the course of its own response. Hence, a constant thematic repetition is necessary in order to underline the sum of the humour’s meaning. Equally, the more low scoring laughter became almost a ritual response to a repetitive motif; a polite communal reaction that merely acknowledged the tutor’s a humorous intonation. But the failure to offer at least a minimal response - to contribute to a communal reaction - indicates (to oneself, to one’s peers, to the profession itself) an uncertainty, even an unfitness, to be a producer of the new ideology. I can summarise the cluster of student jokes in two ways. It was apparent that the tutor’s controlling position was responsible for orchestrating both the prevailing tensions of entry and the collective fears of the forthcoming encounter with madness. For this strategy to be successful the tutor finds in humour a connecting sensitivity to the fears and the tensions of the audience. The genre of practitioner humour played a significant part in articulating these uncertainties. In negotiating these fears, the humour also laid down the desired heroic qualities of self-reliance, emotional control, and detachment. Values that cannot always be comfortably addressed by the public voice. For their part, the students not only internalised these values by their collusion in laughter but also released the tension orchestrated by the tutor. Laughter became a means of socially calibrating a sharing of and the experience of a tradition. The repetition of a motif is processed as a consequential conformity of acquired knowledge. And by this repetition the production of even the minimum of response becomes ritualistic and to be expected. As the lectures progress the raids into the Material Bodily Sphere become less and less. The tensions between the outer and the inner narratives become weaker and the voice of the emerging adepts begin to carry the full weight of the new ideology. At some tacitly calibrated point in the course of the lectures any challenge to the order of things is made unthinkable: 0100J: The wicked witch had long beautiful hair and a lovely gown; The beautiful princess had a hooked nose .....(2). Somewhere between the telling and the response a living interplay has been

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consummated. The narrative of the inner dialogue has been taken over from the tutor and made into jointly crafted ideology.

HUMOUR AND LAUGHTER – THE PATIENT CLUSTER Despite the growth in national wealth the age-old inequalities remain. The position ofthe poor has improved. But so too has that of rich. Frank Field, Unequal Britain, 1973 This section looks at the mad and the function they perform in practitioner humour. Here, an understanding of Bakhtin’s concept of the surplus will be of considerable help. I will also introduce the Ringmaster and begin to make the acquaintance of that living element of the Material Bodily Sphere – the grotesque. Bakhtin’s idea of the Surplus (of seeing and meaning) is useful to any analysis of the way others are classified and the self is affirmed. Surplus works from the self-evident fact that in every encounter the participants see different worlds before them. Occupying a unique position in timespace, each sees what the other cannot see. And because everyone responds to such a variety of otherness the sense of one’s own selfhood is experienced as being open and unfinished. The self sees itself in a state of a changing development while the other is seen in a finished and closed form. In this way not only is sense being made of a disorderly world but the standing of the self is reinforced. Surplus strengthens Bakhtin’s underlying premise that all meaning is based upon a relationship to otherness. In each relationship there is a living exchange of values in which the self, the other, and their attendant backgrounds are created and merged: ‘All these values that consummated the image of the other were drawn by me from the excess [surplus] of my seeing, volition, and feeling’24 Surplus is also descriptive of the full range of social and political relationships to others. The way the biographies are shaped is descriptive of the ways great masses of people have been treated throughout history. Whole populations of people have been seen against surpluses of poverty, criminality, or their dysfunctional beliefs. But at the other end of this ethical continuum others are to be respected solely for being another. Either way we need the other if only to give our own standing a proper social meaning. Bakhtin’s idea of surplus means that the authoring of the mad is a complex process of disavowal and identification. It is also a difficult trap for the practitioner to escape from. Words are already inhabited by strong historical forces and are loaded into every utterance of the practitioner. The

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mystery of the clinical gaze, so painstakingly earned, gives to the practitioner the potential of a single-sided surplus of vision. After all, it was Jaspers who stressed that the clinical gaze must start ‘with a vision of what is essential.’25 The surplus that is framed around the patient must be filtered of its perceived trivialities. Clinical meaning, for Jaspers’s descriptive phenomenology, is embedded in ‘mastering the unendingness [and bringing it] under the control of discerning insight’. So engraved is the thinking gaze upon the practitioner body that narratives about the mad are virtually guaranteed to be those provided by scientific disciplines. Jaspers again: We now seem to find ourselves [...] in the presence of a fresh chaos of innumerable phenomena which have been described and defined, but still cannot satisfy our scientific needs. Delimitation must be followed by the bringing of phenomena into some kind of order, so that we can become aware of the diversity ofpsychic life in a systematic way.26 Stallybrass and White have provocatively expanded the Bakhtinian surplus onto a wider, sociological setting. They argue that in order to develop as professional bodies, the new bourgeois classes were required to separate and distance themselves from the low other of the carnival grotesque. It was necessary for them to dispose of any participatory function they may have held in carnival activity. In this social transfer the form of the low was constructed against a surplus of grotesque logic -bodilyexcess, vulgarity, and the concerns of the lower bodily strata. Accordingly new standings - surplus of seeing sites - came to act as social markers, establishing identities of stability, moral probity and seriousness. For Stallybrass and White this separation is ultimately an illusionary one. A substantial part of middle class identity is formed from the forces it must distance itself from. But in order to service the integrity of its identity it must perpetually rediscover the presence of the everyday grotesque. Often, what the professional body defines as worthy of suppression lies in the grotesque element that has remained, through the ages, indestructible and undefeated. Forced to seek shelter in the margins of everyday meaning these carnival remnants remain as untidy and amoral forces. I make the point that the very behaviours practitioner bodies are so vigilant in distancing themselves from, are in fact, the self-same activities most celebrated with the carnival. Professional codes and procedures silently define themselves against the logic of the carnival; the proximity of human contact, the sharing of food, the consumption of alcohol, the lurid colours of dress, and the more raucous forms of speech. So powerful are the forces that separate the concerns of the high and the low that the internalisation of official values becomes a self-regulatory practice for the professional body. Those points of confusion that arise are

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to be referred to the innate authority of the practitioner. Jaspers employs the concept of authority to invoke an artificial surplus upon the structure of practitioner and patient dialogue. He asks that both the patient and the practitioner collude in visualising the practitioner’s authority. A surplus is authored by Jaspers that consummates the standing of both participants: [The] doctor and patient instinctively adhere to authority as something reassuring. The sensitiveness of the doctor, lest he should not be wholly believed and followed, and that of the patient, lest the doctor should not assert himself with complete certainty, mutually condition each other. 21 The nature of surplus and its potential for plasticity leads my argument towards the premise that practitioner humour represents a significant genre for articulating the struggle between the values of the (neo-classical) high and the (grotesque) low. In competent hands, the joke in the way it manipulates another’s surplus, represents a compelling aesthetic category. Bakhtin: Laughter is a specific aesthetic relationship to reality [it can] grasp and comprehend a phenomena in the process of change and transition, it [can] fix in a phenomena both poles of its evolution’.28 A joke’s narrative creativity is always dependent upon an anticipated response. The art of its telling lies in how it reveals another against a surplus that is intended to excite the expectant audience. Jokes are offered as a means of refining and locating the standing of another. The tutor spreads out before his audience the contrasts of differing voices and values. Here in the lecture room I found that every joke worked to secure the triumph of paternal competence. Not one recorded joke concluded with the patient in the role of hero or heroine.

THE DISPLAY OF MADNESS During the Middle Ages and thereafter, people with deformities and mental disabilities were frequently displayed for money at village fairs or market days. D.A. Gerber 29 Social history has always provided space to satisfy the rational minds need to view the grotesque spectacle. In fairs and festive events throughout the land the anomalies of the deformed and the mad provoked, in equal measure, a sense of disgust and fascination. Such titillating public

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exhibitions directly contribute to the shaping of the neo-classical body. By displaying the grotesque against specifically approved sites the classical body is able to tame and control human aberration. The more the grotesque is seen as ill mannered or gross the more the classical body can generate its own self-regulatory identity. My stay in the lecture rooms confirmed the continuity of this ancient tradition. In turning to the patient cluster of jokes I want to flesh out my argument by transforming the collective tutor group into the composite figure of the Ringmaster. The outline figure of the Ringmaster is one who lurks along all the pathways of this landscape. His is the unnerving presence of something living in the foliage and of peering eyes that monitor that all utterances. The body of the Ringmaster and the association with the circus is a useful analogy in understanding the setting of these lectures. Occupying a space that conjures up the perpetual sense of wide-eyed communal experience, the circus ring, temporarily cut off from the world, is permitted to display and enact the performances of living exhibits. The circus, like the carnival, remains a celebratory space given to the transgressions of the ordered world. The human and the animal, the rational and the irrational, are all wildly intermixed to the collective delight of the crowd. The Ringmaster (for he was a he) is courageously positioned in among the intimidating events of the arena. I also want to add the figure of the old fairground showman to the body of the Ringmaster. We can still witness the continuity of this character, albeit in a technological mutation, in the emergence of the modem TV talkshow host. Andrea Stulman Dennett’s30 persuasive essay on this subject notes how the success of both the fairground pitcher and the TV host is dependent upon an ability to manipulate the display of contrasts before an audience. Where once the public queued to compare bearded ladies against themselves they can now watch from their own sitting rooms the spectacle of obese mothers sat next to slim daughters or alcoholic husbands contrasted against pious wives. Dennett describes how the TV host has inherited the freak-show pitcher’s qualities of presence, eloquence, and personal magnetism. Like the Ringmaster, the success of these exhibitors is dependent on an ability to lead a voyeuristic audience from exhibit to exhibit. In part, the authority of the Ringmaster is drawn from his courageous capability to stand amidst the comings and the goings of unnerving spectacles. Stood before his expectant audience the Ringmaster demonstrates an accustomed independence and confidence towards his task. His evident mastery evoked a reassurance in an audience alarmed at the ambiguities whose existence threatened the categories that govern social meaning. We recall that the Rabelaisian Chronotope, so active in the lecture room, permitted the spreading out of all the connections to older certainties.

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Rabelais, a skilful pitcher himself, achieved such dramatic impact by displaying his characters against the most surprising of surplus linkage. In the same manner, the Ringmaster placed everyday knowledge up against the most unexpected of connections. Ever responsive to the anxieties of his audience he stood before us demonstrating his ability to cast contrasting differences within the same frame. I was fully convinced that a long tradition within the development of rationality was being enacted in the timespace of these lectures. Examples of the historical practice of displaying the mad abound. Michael MacDonald’s31 comprehensive overview of seventeenth-century madness notes that Renaissance Englishmen ‘were fascinated by fools and madmen’. The curious could witness in almost every village ‘insane men and women [who] were perforce on public display’. MacDonald observes that this fascination was not the sole province of everyday folk. Contemporary writers and playwrights relentlessly reworked the potentials of madness and folly: ‘Lunatics and fools were living tropes, simultaneously man and beast, social creature and natural “unaccommodated” humanity’32 Foucault,33 too, highlights the medieval custom of the need to display the mad. In Europe the madhouse at the city gates had convenient windows designed not only for the passage of food and gifts but also for public observation. He draws our attention to the records of Bethlem hospital in London, which in 1815, attracted 96,000 visitors to view its lunatics. It seems an integral feature of Bethlem’s economy that the mad were there to be displayed. Basil Clarke’s Mental Disorder in Earlier Britain34 records that at the close of the sixteenth-century, although the general public could access the interior of Bethlem and its inhabitants, only ‘the “privileged visitors” could make game of them’.35 But the social division between spectators was not always maintained. In the middle of the eighteen-century the spectator sport of ‘lunatic watching’ prospered. Along the galleries of the asylum traders had licence to sell ‘fruit, nuts and cheesecake’. During the Easter week of 1753 a visitor counted at least one hundred spectators (at twopence a piece) making ‘sport and diversion of the miserable inhabitants’. 36 In a more pictorial fashion, William Hogarth’s famous engraving of Bedlam depicts a lady and her maid wandering among the hospital’s inmates. To the shocked amusement of the two ladies a patient is urinating at the foot of the stairs. The lesson of Bedlam is that rationality will never allow its opposite arm the comfort of being left to its own devices. Throughout modem history the irrational body has been animated, made to move, constrained, opened, subdued, counselled, warehoused, tranquillised, domesticated, disciplined. But it is true that public attitudes to the display of madness have changed. And the change is one guided by the restrictions imposed by a unitary

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language that seeks and creates a common accord with social attitudes. However, the allegiance to rationality and all that is deemed progressive, too easily forgets that the positive can only be defined by reference to its negative. Even today attitudes to madness are still shadowed by an ambivalent emotional response: we are at once fascinated and frightened, appalled and attracted. William Cowper, in an eighteenth-century visit to Bethleni, discloses his own heartfelt rationalisation to the scenes he witnessed. His emotional ambivalence to the display articulates the ethical paradox of spectatorship: But the madness of some of them had such a humorous air, and displayed itself in so many whimsical freaks, that it was impossible not to be entertained, and at the same time that I was angry with myself for being SO37. The queues outside Bedlam confirm that a rational superiority, in order to be reminded of its standing, must be fed by repetitive contrasting encounters. And because the rational body strains to dissociate itself from low forces any prolonged contact with the mad was entrusted to the breed of asylum keepers. As intermediaries in the spectacle, these managers of madness, masked themselves in the full delegated powers of reflected authority. With such licence, and to the delight of the gathered spectators, madness was displayed not in some wretched passivity but in an animated and entertaining form: Certain attendants were well known for their ability to make the mad perform dunces and acrobatics, with a few flicks of the whip.38 This same tradition - the display of the spectacle of madness - finds its continuation in the symbolic presence of the Ringmaster in the lecture room. The ‘certain attendants’ have become skilled raconteurs, renowned for their mental agility and quips (‘the few flicks of the whip’), and who can be entrusted to conjure up the anecdotal transformations (‘perform dances and acrobatics’) of madness. We must now look to the art of the Ringmaster who is charged with creating and transforming, exposing and unveiling, the spectacle of madness to the ‘general delight’39 of an audience he is attempting to recruit in alliance. In the lecture room the activities of unreason are given a special vividness through the sociable register of humour. With each anecdote the body of the mad is processed through the most fantastic of transformations: 060Q: Lots of bodies under the floorboards. This, in fact was a delusion (1). This quip is descriptive of the intersection of the realistic and the surreal. In a single utterance the twisted thinking of unreason has been pitted against the laconic dismissal of rationality. The horror of a revealed atrocity is

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allayed by the quiet confidence of the physician’s gaze. Audience laughter is part relief and part awe in the practitioner’s ability to reduce the patient’s voice to an essential truth. And so the Ringmaster continues. To the loud delight of his audience he conjures up the most potent of aggressive acts: 055Q: This is why they tell you to drill here and there [points to skull] and stick a ballpoint pen in (2) (057 063 068. 070 077). With a flick of his whip he parades the most voyeuristic of relationships before us: 059J: You yet [on a video] a whole load of people having epileptic fits! fantastic! (3) (074). Before us all the announces the most terrifying of nightmarish scenarios: 066Q:.... When six burly policemen throw you into a cell with a psychotic (2). Dramatically unveiled before us all are the crudest levels of uneasiness relating to madness: 065J: .... 16 stone nurse called Tiny watching a patient in a cell. Stupidly, I leaned over to look at him and the patient made a grab at me. Tiny had me against the wall .... (3). Before us the Ringmaster parades the grotesque forces of carnival. Our confidence in his expertise is maintained in the continuing triumph of reason and objectivity over the excesses of the grotesque body. The images of the carnival, mediated through mental illness, finds an expansive shelter in this cluster of jokes. The powers of mask and costume are evaluated against Wearing a lot of lipstick, not in line ..... (I); and, rational norms: 053Q: 079Q: .....nicking underwear, wearing it .... (1) (054 072 075). As he spreads out the values of rationality the Ringmaster equally stresses the counter proportionality of its negative aspect. Those values deemed as negative are made to degenerate and ‘in the process its real-life diminution is compensated for by a false idealization in the other world.’40 In other words the Ringmaster has complete licence to pitch malicious distortions upon the target body. He brings the mad body into focus as being gross and frightening: 082J: Patient had a friend described as built like a fork-lift truck with manners to match (1). The bodies of the mad are wildly expanded and distorted. Aflasher is discovered to be a bodybuilder, huge (054). A presenting patient, a sportsman, is very aggressive, a huge man (067). And unkept old men become masturbators with foreign bodies lodged in their ears (061). The extremes of human experience are themselves spread out by the intermingling of knowledge and entertainment: 063J: [ECT is] not a punishment. We don’t say to patients: “Right, ECT” and zap them with it.. . (3). . . They are not dragged down to the room by six nurses,. . (3). ..not usually. . . (1).. . need to dispel these myths (1). And hostile couplings of raw power and refinement is heartily consummated in laughter: 070J: Two or three sessions of ECT. That usually livens them up (4). In these dances and contortions the spectacle of madness is being offered as a bid for an alliance with psychiatry. The invitation to respond is an option continually presented to the audience. At work is the stark choice

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between conformity and dissent. The very authority of the Ringmaster – 048Q: Families do effect children. Most ofyou will see me as a father – least until you get to know me (2); 052Q: My ego is strong. I am firm but fair. Someone said I was known as the hatchet man (2) - is resplendent with all the appropriated powers of the carnival mask. The character who is stood before us is composite mix of the Father, the Judge, the Master of Ceremonies, the Magician, and the Recruiting-Sergeant. His gaze radiates a seductive force that pulls uncertain voices into the security of human proximity. Sadly or otherwise, history suggests the most often chosen direction is conformity. As the days and the lectures tick by I am increasingly aware of the close connection humorous anecdote has to case history. Indeed, my initial assumptions of difference have been unsettled by the complicity that exists between a respectable inner voice and the barbarities of the outer narratives. The presentation of the difficulties people have struggling with their daily needs and narrow cares lends itself equally well to humour or case history. The voice is hardly dissimilar, only the intonation marks off the difference. Both these registers are aesthetic utterances that work to a formula. The voice of the other is sacrificed to a form that is already there already anticipating the event itself. Unable to participate in these exclusive genres the voice of the other is distorted to the level of predictable caricature. Listen to this: 061J: 64-year-old-man. Lived on his own in a sparse flat. All his life worked aloft in a crane. Took his breaks and meals up in the crane. No ,friends. Pyschiatrist called to his flat by the police. Patient convinced CIA had “Araldited” bugs in his ears .... (1) ... Brain waves are beamed in and out. Picked on by the CIA. Forced him to masturbate. “How do you know this?” “Because I never use my left hand.” ... (4) ... You can imagine the policemen and the social workers laughing. I asked him later was he possibly lonely. “Lonely? What with all this lot going on! ’’ ... (3). The voice of the old man is identifiable only through the stylisation of the Ringmaster’s speech. By the means of parodic intonation he re-arranges the dialogue in order to prime the triumph of the duty psychiatrist. The voice of rationality is being weighted against the power of non-rational belief. Whatever sense of openness there is on the part of the old man’s character is closed off to force a rational victory. So controlled is the surplus of this event that its meaning is fully contained by the boundaries of rational understanding. As an anecdote this narrative is a good example of the way a unitary language stratifies other voices against its professional orbit. It should be noted that this joke refers to two other agencies (the police and the social services) whose presence is included to add weight to the physician’s authority. The fact that they both yield to a barely suppressed laughter only

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serves to bolster the imperturbable objectivity of the medical gaze. The Ringmaster displays fully his dominance of the circumstances by suppressing any show of emotion. Triumphantly, he signals the consummation of his victory by being the one who does not laugh.

SUMMARY DISCUSSION The patient is thus and no other Karl Jaspers41 My attendance at the lectures began against an understanding of a unitary language. From Bakhtin I understood how a dominant language came to stabilise itself amid the clamour of lesser bodies. I knew of its distinguishing features: its power to limit the range of another’s voice and its refusal to enter into a dialogue other than in its own voice. At these lectures I gained a deeper understanding of Bakhtin’s philosophy. Namely, a body can only be a participant in any dialogue. It cannot not communicate. In effect, every utterance is an intersection of inner and outer forces and is fated to tangle with the multitude of other living voices. But it falls to the official voice the burden of continually needing to re-discover and demonstrate to others the objects of its distancing practices. The official voice, in its style and poise alone, must always be primed to mark off a distance from the everyday chorus. And before us the Ringmaster paraded the whole genre of madness as a single corporate body. Dramatised to the point of caricature, the body of madness was confirmed as a site of myths and images, a frame of mind, a system of management. The students I sat alongside were undergoing an education made from a series of breaks, crises, and all the uncertain threshold states of initiation. Prevailed upon by an enticing Ringmaster the students were understandably eager to embrace the security of a new bodily proximity. By manipulating inner and outer narratives the Ringmaster spread out the positive values of psychiatry against its negative opposites. In the process all the preconceptions and lay-knowledge about psychiatry were made to perish. In the centre of the lecture room the Ringmaster worked to establish a convention of reciprocal and expected responses. Laughter became the measure of conformity, the expression of bodily coherence. Slowly but surely, the Ringmaster teased out any pockets of dissent. Over the fortnight the laughter gradually became banal and ritualised. Absorbed into the wider body, the voice becomes universal and stable. The Material Bodily Sphere was made to retreat. The transformation was complete.

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Significantly, it was the patient-targeted jokes that attracted the loudest volume of laughter. Some of this reaction can be allowed for in the playing off of anxieties over forthcoming clinical placements. But for me the more compelling explanation lies in the continuity of a tradition within rationality’s relationship to its polar arm of irrationality. To maintain its position rationality must forever demonstrate its dominance to the extent that it can animate, distort or limit the other at will. I suggest that both the form and the function of the psychiatric joke have remained the same, at least since the dawn of modem psychiatry. Foucault records a joke from the age of Phillipe Pinel, which, with only a minor re-embellishment, would still arouse the general delight today: Three insane persons, each of whom believed himself to be a king, and each of whom took the title Louis XVI, quarrelled one day over the prerogatives of royalty, and defended them somewhat too energetically. The keeper approached one of them, and drawing him aside, asked: ‘Why do you argue with these men who are evidently mad? Doesn ’t everyone know that you should be recognised as Louis XVI? 42 Here all the wit and the deceptions, the unmasking of madness and the ultimate triumph of rationality can be placed within the same formulas of the lecture room jokes. Yet it could be admitted that Foucault’s joke might well carry more descriptive powers of the reality of care than any serious narrative could. There is, in the Ringmaster, and, subsequently, his audience, a compelling effect to re-germinate (and thus continue the tradition) the most hostile of anecdotes (the highest scoring levels of response). These aesthetic narratives are passed on generation by generation, career by career, pausing only to take on a new contextual surplus. I first heard the following joke in the early 1980’s and I have played my own part in broadcasting its potency. I am certain Pinel’s new breed of keepers would immediately comprehend its narrative intentions: Mr Smith presents with Echolalia. “Good Morning Mr Smith. ” “Good Morning Mr Smith. ” “And how are you today? “ “And how are you today?” “Sprechen sie Deutsch? ” “Er ... no ... I’m sorry I don’t speak German.” I have made much of the Ringmaster’s skill in dramatising the relationship of one body to another. Because he paraded the body of madness in afinalised and grotesque image he laid upon their body the surplus of exaggerated or fantastic form. In the course of his lectures he regularly opened gaps in which to reach down and draw from the Material Bodily Sphere the tools which alter pivotal points of human imagery. With the most nonchalant ‘flicks of the whip’ he gave order and cohesiveness to a

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mad body whose surface reflected disorder and incoherence. Underlying this display the Ringmaster was always promoting the recommendation of an unspoken set of ethics to the body of students. Rather than thrusting everything at his audience in a highly synthesised form his skill lay in the more dramatically persuasive effects he achieved by the playing-off of extreme contrasts within the sociable context of humorous anecdote. When I found the answers I was looking for I got up and left.

Nash, W., The Language ofHumour, London, Longham, (I 985) PDP: p27 3 ibid. p67 4 ibid. p93 5 ibid. p6 6 O’Sullivan, D. and Dean, C., British Journal of Psychiatry, August 199 1, Vol. 159, p275 7 PDP: p I99 8 SG: p95 9 DIN: p248 10 Palmer, J., The Logic of the Absurd: On Film and Television Comedy, London, British Film Institute Publishing, (1987) p176 11 Legman, G., Rationale ofthe Dirty Joke: An analysis of Sexual Humour, London, Jonathan Cape, (1968) p1 13 l2 Nelson, T.G.A., Comedy: The Theory of Comedy in Literature, Drama and Cinema, Oxford, Oxford University Press, (1990) p7 13 Zillman, D., ‘Humour and Communication: Introduction to Symposium’, in It’s a Funny Thing Humour, eds. Chapman, A.J. and Foot, H.C., Oxford, Pergamon Press, (1977) p294 14 RAHW: p66 15 ibid: p82 16 ibid: p10 17 FTC: p248 18 ibid: p248 19 FTC: pp167-224 20 ibid: p 177-8 21 ibid: p I68 22 ibid: p 169 23 Bergson, H., Laughter: An essay on the Meaning of the Comic, London, Macmillan and Co., (1911) p176 24 AA: p27 25 Jaspers, K., General Psycopathology, Manchester, Manchester University Press, (1963) p3 1 26 ibid: p 1 320 27 ibid: p797 28 PDP: p164 29 Gerber, D.A., ‘The “careers” of People in Freak Shows: The Problem of Volition and Valorization’, in Freakery: Cultural Spectacles of the Extraordinary Body, ed. Thompson, R.G., New York, New York University Press, (1 996) p43 1

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Dennett, A.S., ‘The Dime Museum Freak Show Reconfigured as Talk Show’ in Freakery: Cultural Spectacles of the Extraordinary Body, ed. Thompson, R.G., New York, New York University Press, (1996) 31 MacDonald, M., Mystical Bedlam: Madness, Anxiety and Healing in Seventeenth-Century England,Cambridge, Cambridge University Press, (1981) 32 ibid: p I47 33 Foucault, M., Madness and Civilisation, p68 34 Clarke, B., Mental Disorder in Earlier Britain, Cardiff, University of Wales Press, (1 975) 35 ibid: p24 1 36 Masters, A,, Bedlam, London, Michael Joseph, (1977) p47 37 cited in Porter, R., Mind Forg’d Manacles: A History of Madness in England from the Restoration to the Regency, Harmondsworth, Penguin, (1987) p9 1 38 Foucault, M., Madness and Civilisation, p68 39 ibid: p69 40 FTC: p I68 41 Jaspers, K.. General Psychopathology, p804 42 Foucault, M.. Madness and Civilisation, p262 30

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Chapter Four

Dialogues of the Classical and Grotesque Body The Unofficial Terminology of the Care Chronotope

button missing collapse collapse again * coming apart at the seams crack cracked crackers cracked-up crackpot crazy * disintegrating* dismantled * fall apart * falling to bits * fragmented* fragile (very) * flakey falling to pieces functioning (not actually) * hung together" haywire intact (stays) * lacks good sense lacking loose in the head lost his marbles lost his faculties lost it all* not all there not quite right not right not playing with a full pack not running on all cylinders not quite there* screw loose shattered slightly crazy * smashed time to collect themselves * vacant wanting witless wrecked wobbly (throw a) *1 The Care Chronotope is indeed a curious landscape. All around me is the ceaseless activity of bodies and voices. So prevalent are these activities that the body and the word have become my principle co-ordinates. Everywhere bodies are in the process of coinciding with, or departing from, a relationship to other standings. Some bodies lend themselves well to the fusion and come to take on a voice indistinguishable from the larger assembly. Others have a more troubled tenancy, uncertain about their own voice, awkward with another, never quite knowing where they stand. In this section of my journey I remain located in the lecture room. Here, my task is to record the Ringmaster's use of unofficial terminology. In total, I have collected 118 terms - indicated by an asterisk – such as off their heads * or slightly crazy*. At times I grow impatient at the repetitiveness of the lectures and I begin taking occasional strolls down the corridors of the clinic and across its car parks. Because I am a polyphonic traveller these short interludes mean I get to absorb a wider profusion of voices, each with 73

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its own wisdom and its own intermingling of meanings. A busy practitioner bustling about the clinic will engage with a dozen different voices in the space of an hour: a colleague, a student, a relative, a receptionist, or even a patient or two. ‘All peoples,’ Bakhtin reminds us, ‘have enormous spheres of unpublicized speech, non existent from the point of view of literary written language.’2 I have grouped together a number of words generally considered to be at the low end of oral discourse and have named them the genre of unofficial terminology. This genre comprises the lay words or common idioms that are descriptive of deviant mental states. Nearly all of its terminology has been imported in from the wider social fabric. Psychiatry appears content to share its unofficial terminology with the bubbling cauldron of the folk lexicon. In these terms we have the basis of a shared ideology that straddles two different social domains. In the previous chapter I described how the surplussing practices of the Care Chronotope mapped out the corporate body of madness in grotesque terms – “huge and aggressive,” “lipstick not in line,” “built like a fork-lift truck.” I now want to expand this line of enquiry and demonstrate how this activity can lead to the contradictory fusion of care and terror. The collapse of these themes into each other is a consequence of the way classical and grotesque bodies are encoded in the Care and Patient Chronotopes. I will argue that the classical body cannot be content merely to distance itself from the grotesque. To sustain its wholesome standing the classical body gains a more compacted unity by way of fragmenting the body of madness. The substance of this part of my journey addresses the way the ambiguities of the body retain their value in unofficial genres.

THE RE-ARRANGEMENT OF THE BODY Leonardo da Vinci’s famed Vitruvian cartoon in which a naked man is proportionally balanced at the centre of an encircling universe is symbolic of the huge philosophical shift that separates the humanistic from the Gothic world. His cartoon embodies a new chronotope with Man firmly located as the central conceptual pillar in which to explain the new cosmos. The new Man is presented in a mathematically balanced dimension with his outsplayed arms and legs squared within a measured circle. But to secure this standing a new system of time is necessary. To begin with there must be a temporal change in direction. The portrayal of the body as the centre of the universe requires a single sense of backward to forward time. In the idea of progress a linear development of a horizontal time is introduced. As Bakhtin observes, from now onwards: ‘Philosophy, scientific knowledge, human practice and art, as well as literature, all worked on this new model’3

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At the same time the import of the old vertical and cyclical systems of time are reduced and shunted into the background of rational consideration. Leonardo’s cartoon symbolises a changed timespace through the medium of the body but it is a body that was developed at the cost of separating the new body from the earthiness of the old Gothic world. When this severance happened the effects were striking. The new body lost the ambivalence of the old cosmic order. The circular interaction between nature and bodily regenerative processes was severed. And as the old interpenetrating connections were discarded, the body became closed and self-sufficient in a new rational selfhood. Aesthetically, the body reached back to an earlier history and suffused itself in the Graeco-Roman ideals of the hero. Graced with an old but noble standing it laboured vigorously to elevate itself above the hawking and hirsute Gothic below. In accordance with classical form, the bulges of the new body were politely smoothed out, its orifices were hidden, and its focus was shifted resolutely onto the head and a proper upright posture. Erect, individual, and heroic, the neo-classical body sought out its reflection in the notions of intellectual reason and bodily proportion. People and things may well be different, went the new reasoning, but if the variations stray across classically understood limits then the body is at risk of losing its coherence. Into these limits a ‘backward to forward’ temporal expectation of progress is introduced where a sense of usefulness becomes a fixed part of proportion. Take, for example, the form of pottery – urns, pots, mugs, - which have always held a balanced sense of function to proportion. A pot can have many features but its proportion must cater to the pot’s function. Once a pot is taken across certain limits and becomes crazed or cracked then it carries a suspect utility and is greeted by a common response – rejection, exclusion, and ornamentation. Notably, the descriptions of poorly functioning vessels find an associated meaning in the colourful expressions of unofficial terminology: crack-pot, crackers, crazy, crazed, half-crazed, slightly crazy, cracked-up, potty. But I don’t want to stray too far from the body. The new selfhood was to be issued with new topographical co-ordinates. Where once the body pivoted around a centre ‘in which the upper and lower stratum pentrate[d] each other’;‘ the new co-ordinates of Leonardo’s Man re-arranged themselves around the expressive features of the body: ‘the head, face, eyes, lips, the muscular system’.5 Physically, the lower bodily strata was to be well hidden and its never-ending functions were to be assigned to the private or psychological aspects of selfhood. The lower bodily strata, effectively made silent and inconspicuous, surrendered its ancient philosophical tasks and withdrew from the public concerns of the rational head. According to Bakhtin, this separation was to be achieved by seven identifiable areas of life – he called these the Series, the very working material of the carnival:

76 1. 2. 3. 4. 5. 6. 7.

Language For Those Who Have Nothing The body’s anatomy. Clothing. Death. Defecation. Food. Drink and Drunkenness. Sex.6

It is relevant to my enquiry that these still potent forces remain open to examination. The Enlightenment is an on-going process rather than a battle won. As a polyphonic traveller I cannot accept this complex historical period as the overthrow of a fixed cosmic order by the triumph of reason. Neither is it the full defeat of circular time by the onward march of scientific linear progress. This way of thinking neglects the courtesy observation that the flesh is willing to surrender its ancient duality. Nor can I assume that the grotesque logic of the Material Bodily Sphere is content to accept its discarded status. I concur with Bakhtin that the forces of carnival remain ‘indestructible’7 and continue to live and find shelter in every social formation. From the point of view of the Series the professional body becomes almost a masquerade built upon a site of separation in which it must continually struggle not to reveal the ambiguity of the limits it strives to narrow down. As a body it must appear closed and satisfied with the sufficiency of its own language. Any awkward bulges or glimpses of bodily apertures that would threaten bodily limits are to be mutually smoothed over by the collective proximity of one’s peers. Eliot Freidson’s Profession of Medicine8 gives an excellent example of the professional body being separated from the Series and reconstructed in a classical mould. Freidson refers to Florence Nightingale’s determination to transform the nurse from the ‘stereotype of drunken and degraded Sairey Gamp’ into a semblance of the neo-classical figure. Single-handedly, Florence Nightingale converted the old Gothic image of the nurse into a neo-classical form that stifled or made invisible any reference to the Series: Her first efforts were to strip them of any femininity they had and place them above moral reproach. She gave them ugly uniforms, refused to allow them to wear any ornaments, forbade them to go out except in the company of another member of the contingent, and rationed alcohol9 Miss Nightingale’s leadership is characteristic of the on-going process of the new selfhood. Her re-arrangement of the professional body meant that the concerns of the lower bodily strata – the ‘ever-unfinished nature of the body’10 - became shrouded from the public gaze. By transporting the body

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beyond any suggestion of the Series Miss Nightingale was eminently successful in smoothing down the profile of the nursing body. The tradition continues, not only by leadership, but also in the collusion of other voices bonded together by a determination to see themselves as a properly proportioned and rational body. The point is an important one. The massaging of the professional body is a mutual act. It is the shared social responsibility of all members of the Care Chronotope to manage the classical form. But I go further than this. So paramount is the maintenance of neoclassical imagery that any slippage into the Series can find itself assigned to a collective form of invisibility. So vital is the desire to maintain the balanced ideal that selective forms of communal perception are used to override activities that appear obvious to the unprepared traveller. It is an unsettling moment to discover that the body of the Care Chronotope is arranged so that no accommodation can be granted to the grotesque logic of the Series. This is a bold statement but one that is easily demonstrated. Take, for example, Deborah Brooke’s11 study of 146 physicians who continued in practice while engaging in substance or alcohol abuse. What is important from her paper is the ‘astonishing’ level of tolerance given to the physician by his or her colleagues. A degree of tolerance that can only work from a selective vision that surpasses the point of visibility. Even though some physicians were known to fall into drunken stupors while interviewing patients they continued to practice as soon as they regained consciousness. In some clinics staff discover empty bottles of Vodka hidden away in filing cabinets and storerooms. And at subsequent enquiries, nurses gave accounts of physicians swearing at relatives or publicly reprimanding clerical staff. Seemingly the classical body must be seen to wallow in the Series before its fall can be recognised. The voice of the Care Chronotope is contained by some highly restricted bodily contours. After all, how can it enter into dialogue with something it is already deeply implicated in? How can a body associate with a region that is there but not there? In the meantime, the falling body of the practitioner is blatantly placed out of focus, kept alive and upright only by the frantic massaging of others. At all costs the classical body must be kept in proportion and erect.

TERROR AND CARE The notions of terror and care do not add up to a whole in the general understanding. More, the one notion is positioned at the extreme opposite of the other. Terror, shot through with evil and cruelty, seems far removed from the virtues of care and compassion. That this is self-evident is to deny the method of travel the polyphonic traveller engages with. So far my

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journey has shown how the neo-classical posture comes to shed certain perspectives. Adapting the body to the heroic stance has meant that certain perspectives are not required or even needed. The neo-classical body is only marginally committed to other timespaces. In the genre of practitioner humour the students were seen not as other but as out there. The mad were seen not only as other but also as beneath. Both bodies provide suitable targets: others who are needed to be beneath or outside in order to prime the foundations of the practitioner’s standing. Because the psychiatric landscape is so contaminated by the background noise of the Material Bodily Sphere it is almost a commonplace to encounter grotesque realism’s power to violate and collapse the official structures of binary tension. At every intersection there are clusters of differing elements of opposing polarities: the mad and the sane, the serious and the stupid, the official and the unofficial, and the notions of terror and care. Given sufficient space it is not too long before the carnivalisation of these elements merge one into the other. However unpalatable the idea may be, the compression of terror into care is no stranger to the caring landscape. Gregory Bateson and R. D. Laing’s observations on double-bind relationships ably illustrate how children are divested of their own integrity in the most benign and loving of ways. Under the influence of the doublehind, children are brought up in a relationship where affectionate and caring words work to humiliate and even destroy the child. For my purposes the lesson to be drawn from double-bind’s simultaneous expressions of love and hatred lies in the characteristic feature of all dysfunctional relationships: namely, the narrowing of perception and the destruction of the living elements of each word. In all those environs – prisons, barracks, - where human feelings are not needed visual perception are restricted and words are made monosyllabic. The restrictions imposed upon what is seen, the closing-down of human proximity, are matched only by the stark poverty of voice. What is terrible, what is loathsome, loses its sense of grotesque surprise and becomes endurable through its very familiarity. Terror, domesticated within the embrace of care, rapidly buries itself in some justifiable explanation to the extent that it appears only in disguised form. In this contraction it can hardly signpost itself openly. The development of my argument can be readily transposed to the experiences of provincial psychiatric practices. I refer to the spate of mental hospital exposures that scandalised the country throughout the 60’s, 70’s, and 80’s. I do not accept these public disclosures of terror as the property of a particular epoch in psychiatric care. The collapse of terror into care is a continuity of the old form of barbarity transformed into a new context. Barbaric acts have always adapted themselves to changing timespaces and find shelter in any system of indifferent dialogue. Since the 1980’s, the

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contraction of terror and care has displaced its physical emphasis and evolved as sexual abuse: an activity which in itself is a contraction of love and terror. Newspapers regularly record court cases or enquiries in which regimes of barbarity are sexually acted out through the bodies of others. The voices that animate the inquiry reports are heavily seasoned with a perceptual selectivity and monosyllabic discourse. They are voices that not only reveal the lengths the Care Chronotope will go to protect its boundaries but they also contain the similarity that all regimes of care and of terror can be reduced to. At Ely Hospital, towards the end of the 1960’s, a government sponsored Committee of Inquiry cross-examines a senior member of the Hospital Management Team against the stark evidence of grossly inhuman ward regimes run by ‘minimum numbers of staff with ‘no experience of care’: Q. Have you always been perfectly happy about what you have seen here.? A. Perfectly. Q. In fact, you did a long inspection of the hospital yesterday? A. Yes.12 Attempts by the Committee of inquiry to pin down the responsibility for overseeing the hospital became lost in the numbing hierarchy of the hospital. Examples of restrictive vision are sprinkled throughout the Committee’s report. A Regional Health Board physician offers the excuse that it had never been ‘incumbent upon him to prepare any report about the quality of the service.’13 Another senior visitor, despite attending the hospital on ‘20 or 30 occasions’ had ‘never been led to regard himself as having any inspectorial role as to the standards being attained there.’ But it would be wrong to attribute to these practitioners a badge of an indifferent cruelty. They relate their narratives to the inquiry in this way because that is the way the ideals of neo-classical body determine them to be. Almost all practitioners must follow, with more or with less satisfaction to themselves, the life of their chronotope. Because the narrative they tell are protected by an enclosing unity the defendants are free to create new normalities, each one striving for a greater degree of communal familiarity. By all accounts the barbarous events at Ely Hospital were so familiar that they could be reached out and touched. Terror had become so domesticated with the space of care that it could not be seen. The evidence of ‘Mrs Z’, an official of the Regional Health Board, summarises this state of affairs exactly: ‘One lives [. . .] with a situation so long that one no longer sees it.’14 Yet a very small majority, with great hesitation and at much personal cost to themselves, emerge in every historical period. Those, who in Trevor Griffith’s phrase, ‘dare to see’,15 and come to speak the unsaid and the

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unseen, are subjected to alarming sensory experiences that usually must be suffered alone. The whistleblowing body is divested of its collective flesh and made to feel isolated and abandoned. The eyes are opened wide, the voice made to stutter, and the bodily apertures are loosened. Here is part of a statement of one nurse who waited to complete her training before summoning the courage to lodge a complaint: I was walking in town the other day and I saw one of the SENS [an unregistered nurse] and I was really terrified. I was running the other way quicker than anything. Plus the fact I was up the market one day and I saw the male auxiliary – the nasty one, who I’d had a few skirmishes with – and you know when you ’re really frightened, and your hearts beating and you ’re sweating and you think, ‘Oh my God, what am I going to do? ’ I was so terrified [. . .] I couldn ’t cope with the strain.16 To be a voice-carrier in the Care Chronotope hinges on a particular collective perspective. To break from the collective narrative is to take up a position that confronts both the official and the unofficial bonding of its community. Even the lowliest of heroic acts have powerful bodily and social consequences.

SLEEPING WORDS Before psychiatry emerged as a scientific discipline the descriptive terminology for mental illness was scarcely separated from its popular roots. A glance through early literature reveals not only the limited number of terms but also the sense that there was little to distinguish between official and unofficial usage. Michael MacDonald’s study of the physician Robert Napier (1559-1634) records his use of only four terms in relation to his mentally-ill patients: mad, lunatic, distracted, and light-hearted.17 Thomas Szasz points out that despite Shakespeare’s rich vocabulary he employs only a handful of terms to refer to madness.18 In fact, the Shakespeare Thesaurus lists 32 words that are descriptive of madness: mad, mad-brain, madman, madness, bemad, melancholy, bestraught, brainsick, distract, frantic, frenzy, insane, lunacy, lunatic, lune, March Hare, midsummer madness, stark-mad, moody-mad, rage, rave. wood, disanity. distraction, fanatical, jury, hysteria passio, mad-headed, madly, madwoman, non-come, passion .19 Nowadays, many of these words would find themselves assigned to lower levels of the explanatory scale with a clear identity-forming line of legitimacy drawn between official acceptability and an unofficial inappropriateness. It is possible to sketch out a scaled vocabulary ranging

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from the high seriousness of DSM IV down to the low levels of everyday understanding: Brief reactive psychosis Undifferentiated Schizophrenia Schizophreniform disorder Bipolar disorder Disoriented Unbalanced Insane ---------------- approximate line of separation Out of touch Bizarre Flipped Dolalley Nutter But listing these words out of their context suggests there is value to be gained in an etymological approach to unofficial terminology. This line of enquiry is a tempting one. Judith Neaman20 is an historian who, unfashionably, followed the continuity of psychiatric development across several centuries. Her argument on vernacular dialect proposes that although conscious awareness of original meaning may well have been lost, some of the underlying beliefs continue to preserve the survival of ancient ideas and attitudes towards mental illness. Her argument is seductive, after all, what can we mean when we say a patient is beside himselfor has lost his senses other than we retain beliefs that the soul is capable of transmigrating the body. But the original development of words and speculation on their meaning does little to awake the forces they probably once ably communicated. Etymological approaches to unofficial terminology do little more than feed the curiosity of the intellectual appetite. A good example of this most addictive of fascinations can be illustrated by the relationship of air to mental deviation. Constantine the African, the most famous physician of the 11th century Salerno medical school, was responsible for formalising the long-standing principle that the three regions of brain (the senses, reason, and memory) were governed by the transmission of pure air. Accordingly, deviant mental states were deemed to be caused by bad air or the mal-function of transmission processes. The connection of Fool to air carries the same ancient lineage being rooted in Old French and Latin contractions meaning bellows or windbag. The Fool's famous bauble, the other of the Fool's conversation, was originally an air-filled pig's bladder. Gooseberry Fool, the medieval dessert, earned its name because of its light and airy texture.

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To describe someone as possessing airy-fairy ideas implies a similar textual quality. Old Italian gives us Buffare – to puff – and, hence, Buffoon. William Willeford21 offers a further derivation to Fool. The Italian Coglione links Fool to an air-filled scrotum. And, hence, we still use Balls! or Bollocks! when we mean nonsense. Further examples abound: Barmy (weak minded, 16th Century froth on yeast), blow (one’s mind), babble, bubble, blown (he’s), empty-head, light-headed, full-blown, hole-in-the-head. The argument that words like buffoon or barmy carry some continuous link to our ancestors must be treated sceptically. For Bakhtin, such studies arise from a ‘passive understanding of language’22 in which the neutral significance of words is favoured over a living and contextual meaning. Removed from their dialogical potential these words passively sleep away on a page leaving no opportunity to contribute anything new to their use. But towards the end of his life Bakhtin came to apply the concept of Great Time23 to the words of the past. Those words that are passed one to another across the expanse of historical time take on a certain currency as they enter into Great Time. For my purpose words such as cuckoo or cracked have discarded little of their meaning over four centuries and are readily recognisable in Great Time. Following Bakhtin, these words could be said to have absorbed the ‘taste’ of a particular age and have come to possess a 24 ‘stylistic aura’ achieved by many years of living intonations. From the idea of Great Time it is possible to identify a characteristic of unofficial terminology, namely, that it continues to retain and generate a radiance of meaning. In contrast, the official word generates a profusion of terms but, characteristically, discards them in Small Time. The two qualities are in keeping with the defining qualities of the Care and the Patient Chronotopes. The former, driven by its rising and falling therapeutic enthusiasms, draws upon homeless genres (Latin, Greek, High German) to generate a classically glossed system of terminology. As official terms fall from favour in small time they are courteously forgotten and allowed to die. Indeed, the official terminology of small time can change with such rapidity that systems of classification, common at the start of an individual career span, will be unrecognisable, even unthinkable, on retirement. Official classifications, names, and titles are generated at a level of superficiality more applicable to consumerism than a declared intent of measured consideration. In small time “patients ’’ are have been abandoned in favour of “clients,” ‘‘users,” “service recipients,” “customers,” or even “survivors.” Asylums, too, have changed from “Psychiatric Hospitals ” to “Clinics ” to “Departments of Psychological Medicine ” to “Psychiatric Units ’’ to “Community Psychiatric Health Centres.” All too predictably we know these official words are fated to die in the small time in which they presently prosper. Bakhtin: ‘Everything that belongs only to the present dies along with the present.’25

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THE SMOOTHING-OUT OF OFFICIAL ENDS BY UNOFFICIAL MEANS It is obvious that this man presents with a cognitive dysfunctional profile. In fact he's cracking up. The Ringmaster Almost imperceptibly, unofficial terminology commits its participants to a different reality. The aura that brews within these words represents the suspension of common-sensical beliefs. Freed from the confines of small time these words taste of a meaning which ‘is not in the least concerned with the stabilization of the existing order.’26 For example, if I turn my attention to the oral tradition of possession and its various naming-words then I am obliged to invest a given explanation with all the flavour of ancient narrative. Demonic possession once stood as the most prevalent of explanations for insanity. Where cause and effect once carried a considerable magical connection, possession was viewed as a spiritual illness. Explanation was the proper province of the theologian whose doctrines pervaded medicine, the law, and morality as well as popular belief. Commonly, an alien or magical explanation was offered to account for the most alarming aspects of human behaviour. But even today the well-tested tradition continues of breaking down distressing manifestations into the motifs of nursery rhymes or everyday idiom. In this way the power of some terrifying original experience is reduced and made familiar. All the following naming-words refer to the act of possession. The words carry a distinctive taste of a narrative form that is still available to lessen the terror that a scientific rationality has failed to eradicate: Bats batty bedevilled beside herself bewitched boggled creep creeps up* cripples you* can really cripple you* cure worked like magic* dabbled* flying feel they are going mad* unable to know what's happening* loony lunatic loss of control not feeling right in themselves* moonstruck pops into* possessed shadow of former self* in good spirits* take leave of senses touched they're not there* total loss of self* In the lecture room it is notable that when the Ringmaster is least able to explain a phenomena in the official dialect he is more likely to resort to forays into lower registers of meaning. If I leave the lecture room and wander into the library I should be able to find the same response replicated in the official textbooks. I already know that contemporary textbooks offer

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scant accommodation to lower registers of understanding but if I deliberately select from the library shelves those topics that seem the most incomprehensible to psychiatry then I should reasonably expect to find a degree of unofficial penetration. Accordingly, I choose the complex area of Obsessive-Compulsive States, that distressing condition where the patient is exclusively absorbed in ritualised acts – hand washing, repetitive thoughts, or in the constant checking and re-checking of a household task. The symptoms of obsession have always been highly resistant to therapeutic intervention and the condition remains a phenomenon of considerable explanatory difficulty. Here on the library shelves I found the Ringmaster’s formula to be intact. The official texts do indeed reveal their uncertainty and quickly loosen the boundaries of an otherwise unitary narrative. On these shelves at least it is evident that all the clinical descriptions of ObsessiveCompulsive States are shadowed by metaphors drawn from the ancient notions of possession, intrusion, exorcism, and a hopeful return to God’s good grace. The emphasis is added: Compulsion may be said to occur when an individual is haunted by conscious contents although at the same time he judges them as senseless or at any rate senselessly insistent. Schneider, K.27 [I]f they [phobic stimuli] cannot be banished from consciousness, but force themselves upon a patient’s attention so that he is obsessed by them against his will [...] they invade a patient’s mental life unbidden and unwanted, to monopolize it stubbornly for many months and often years. Kraupl-Taylor, F.28 Compulsive rituals which have been built up over the course of years cannot be expected to lose their grip immediately. The patient will usually report that these modes of behaviour do not seem to have their old compelling power [...] In very few of our patients have we seen these symptoms abolished immediately; they have, rather, diminished in the course of months after the operation, as careful re-education and discipline implanted new patterns of behaviour. Mayer-Gross, Slater and Ross29

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[A]n individual plagued by doubts [. . . ] the intrusive and inappropriate quality of the obsessions DSM IV30 And, without any sense of irony, G. E. Berrios, in an authoritative paper on the classificatory issues relevant to Obsessive-Compulsive States, notes that: Terminological and taxonomic difficulties have obsessional disorders since their clinical inception.

bedevilled

the

Berrios, G. E.31 All of these metaphors – haunted, plagued, lose their grip – are a further lesson in the way that the classical body employs the grotesque to smoothout the proportions of its own profile. The Ringmaster's sleights of hand and to see them in action depends entirely on where one is positioned - must be observed quickly. The words he conjures up are so overpopulated with previous meanings and so flattened by great time that they become cliches and it is possible to lose sight of their stylistic aura. In this sense the Ringmaster is provided with a collection of metaphors in which the awkwardness of interpreting context-specific episodes can be readily translated into a stereotypical form. By foraging in the lower levels of meaning he his able to offer a closure on an official response. But his clever juggling of registers pose two important question that are relevant to polyphonic travellers. Which voice in his utterance actually shapes the care and the treatment given to the patient? And, if encounters with this condition are to be understood in the terms of bedevilment, what factors structure the potentials and the limitations of any subsequent dialogue? The standing of the Ringmaster's magic is revealed. Distance and detachment are being calibrated. Bodily apertures are being filled-in. Awkward bulges are being smoothed- out. The surprisedness of an encounter is deflected and made familiar. Official ends are being met by unofficial means.

THE SURPLUS OF THE THIRD Reason that overcomes itself becomes violently ecstatic. Consciousness on the plane of content appears as anarchic license, bounded by nothing exterior to itself: Special bodies emerge that do not require for their existence any foundation from outside. M. Ryklin32

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One of the unhealthiest regions on the psychiatric landscape, and one of the most difficult to smooth over, is to be found where the calibration of detachment becomes over-heated. By straining to distance itself from lower bodily concerns the heroic ideal of the classical body violently distorts itself. In these precincts the practitioner takes on a purely monological voice in that the “them” have little relevance for the “us.” This is a voice stylised by an exact and narcissistic self-confidence. At its extreme the voice is characterised by tough-mindedness and a preoccupation with dominance and submission in relationships to otherness. In this voice the perceived conduct of another is narrowed until he or she is made adequate to a desired surplus. In its crudest form – though rarely is it signposted – it can be encountered in the conformity of canteen cultures or barrack room banter. Here, utterances are highly seasoned by strongly puritanical voices in which function and proportion appear to be the only aesthetic yardstick. Reluctant to consider ambiguity or ambivalence the bodies of others are judged by their usefulness. Rampton Hospital provides two examples from one of their ward log-books: Rather prone to argue the point, today became disgruntled when his shortcomings were highlighted. This behaviour indicates his shallow acceptance of any authority and poor self-control. Is the definitive layabout. A still-life practitioner who can only be rnotivated by constant attention, he will continue to avoid work at the earliest opportunity. Report of the Review of Rampton Hospital33 The polyphony traveller is not empowered to offer observations on good and evil, right and wrong. More, the traveller proceeds on a diverse landscape where every chance encounter involves a voice, however unpalatable, that is recognised as being firmly interconnected, one upon the other. Under such conditions I can only suggest that the solutions lie not in any striving for a system of unitary ambition but of an insufficiency of knowledge in the complex nature of how strangers care for other strangers. But for now my inquiry returns to the lecture room and continues with the way the Ringmaster draws his initiates into an alliance. Of course, the implications of the Ringmaster using the term loopy* are significantly different from that of a student. At one point in a lecture this observation is put to the test when a student frames a question: “But if we say this patient is crazy.... ”, only to be immediately interrupted by the Ringmaster: “But you cannot use that word.” Such a reprimand firmly reminds his audience who

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has the power to mediate between different ways of viewing the world. According to Jerry Palmer34 the wider the social status in a gathering, the more formalised the register becomes at the less prestigious margins of the dialogue. Towards the centre of the arena the more powerful personnel have the freedom to periodically engage in displays of humour and the use of low terminology. Even if their word seems to directly subvert an official belief, the utterance demonstrates a wide knowledge of the world and its ways. So in using the terms oddball*, mad*, off his head*, the Ringmaster, firstly, displays his privileged freedom to use this vernacular, and, secondly, by intoning the term in levity, he ranks one genre as being more acceptable than another. Morson’s essay on Bakhtinian parody, reminds us that paraodic utterances always contain two voices counterpoised against each other. One voice represents a ‘higher semantic authority’ in which ‘the audience of the conflict knows with whom it is expected to agree!’35 Morson’s observations are accurately descriptive of the process at work as the Ringmaster displays low registers before his audience. There is a further Bakhtinian concept by which the Ringmaster can be said to draw his audience into the official body. I refer to the notion of addressivity, a component part of every living utterance, meaning that unless we direct our voice to another the act of projecting an utterance cannot exist.36 The genre in which we choose to cast our voice is as much defined by the kind of addressee we enter into dialogue with. The Ringmaster’s intermingling of low and high terminology reveals the full potential of unofficial terminology and the surplus positioning of addressivity. Ilkka Joki, a commentator on Bakhtinian speech, observes that the characterisation of another ‘as the addressee of a blend of official and marketplace speech, cannot actually be regarded as “one of us”, but not quite as an outsider either; it is the “the Third.”’37 Accordingly the idea of the outsider is a misnomer. However much the other is shunted out into the margins of life they still retain a relationship to another. It is of interest that Freud employs the idea of the Third in his work on jokes. For him the Third is the necessary target of hostility or lust in the telling of smutty jokes. As example he cites the position of a woman exposed between the position of two men: a joke-teller and his listener. The teller, hindered in his ‘libidnal impulses’ towards the woman, his forced to recruit his listener as an ally. As such, the ‘woman’s incapacity to tolerate undisguised sexuality’ becomes the way of satisfying the teller’s hostile drive.38 There is a slight but important difference between Freud and a Bakhtinian use of the Third. For Freud, the physical presence of a third – the woman – is not always necessary to the intentions of the discourse. Smutty jokes are regularly voiced among men as well as in mixed company. By contrast, the Third person necessary to the addressivity of unofficial terminology must not be present. To address these

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naming-words directly to a patient would transform their meaning into insult. It follows on from this that the specific utterances of unofficial terminology contain a particular addressivity, an utterance that is directed towards another who is not there, ‘an indefinite, unconcretised other.’39 In the lecture room the Third is actively made invisible and inaudible, an anonymous representative of another body. The placement of an addressee who is absent gives licence to radically distort the image of the missing interlocutor. By closing off the potential for dialogue the ground is set to reconstruct the Third with a highly mobile topography. Naming-words addressed towards the Third, offer the classical body in return a sense of stability, a fleeting affirmation of mutuality in which participants can confirm themselves against everyday definitions of standing and competence. Generally, the ability to cope and to attend to a task-in-hand is descriptive of a self-sufficient individual. One, ideally, should stand on one's two feet, have both feet on the ground, or, decisively, know where one stands. These and many other maxims shield a complex prosaic wisdom that holds as central a functional response to a proportioned time and space. From this principle alone it is possible to jointly create a bodily image onto a Third other. What is being measured is the wholesomeness of one body against the fragmentation of another. In the close proximity of the lecture room we all discover, in the Ringmaster’s fragmentation of the Third body, the confirmation of our own proportion.

THE AESTHETICS OF FRAGMENTATION Agriculture was always associated with the Asylum landscape. The walls or the railings of the institution oftern bordered full working farms that produced, in some cases, highly profitable cash crops. Beneath the sight lines of the Asylum clock there was everwhere a distinct orderliness about the symmetrically arranged fields. On this land the farm provided a well kept hinterland where working parties of patients filled in the regulated expanses of time. From such traditions agrarian metaphors grew and provided the Care Chronotope with furter descriptive powers: barking bed-down bin cabbage cagey* cuckoo fruit fruitcake funny farm haywire tether (end of) vegetable wild* wild and aggressive* At this same level of understanding the Report of the Committee of Inquiry into Whittingham hospital records a statement made by the Chairman of the Hospital Management Committee to the effect that his longstay patients were the type ‘who sit around all day doing nothing but

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becoming cabbages.’40 Somewhat naively the Chairman is drawing from a cluster of unofficial agricultural metaphors. The term cabbage is more appropriate to the life-giving and the life-taking earth rather than the tight constraints of a parliamentary committee room. This otherwise innocent metaphor sits uneasily amidst the sombre tones of the official text. But are we not justified in proposing that the role of the cabbage is more accurately descriptive of a reality adequate to the conditions it portrays? Does not the cabbage reliably reflect the real position of poorly staffed wards tending to crops of patients in an ordered array of beds? It cannot always be claimed that unofficial terminology is exclusively directed to the negative portrayal of the Third. Occasionally evident in the lecture room were terms stylised by a clear compassionate intent. If the Third can be re-thought on the level of the Material Bodily Sphere – up the pole*. off his head*, they 're not there*, over the top* - then compassionate tropes of therapeutic intervention can be offered in a complimentary terminology: bringing him down very slowly*, calm them down*, settle down*, keep her up*. And in the same way that the notions of air or possession once explained the management of the mad to earlier practices we can see how contemporary beliefs in electrical connections have found their place in the unofficial lexicon: ,flicking very quickly*, flip*, jerks them out of it*, switch *, switch off*, switching off*, whizz*, zap*. But this positive direction is a minor distraction to the principle object of the body and the word. Bakhtin's central insight in his study of Rabelais focused upon Rabelais's urgent social commentary on the critical transformation of the new human condition. In separating the new Man from the old Gothic, Rabelais displayed the body to fantastic effect. If Man was to become the ‘new measuring rod for the world’ then it was necessary, argues Bakhtin, to present the body in ‘all its parts and members, all its organs and functions, in their anatomical, physiological and Naturphilosophie aspects alone.’41 Rabelais is more than happy to oblige. Throughout his writings the body is entered upon a ruthless anatomical display. In quite incredible topographical shifts, the body, with the aid of vivid permutations of the Series, is incessantly contrasted between its upper and lower aspects. Previously hidden organs are turned inside out and upside down. Eyes are made to pop, skin sweats, limbs convulse, and the spasms of birth and death become matters of the public domain. I have described how the body took on its new co-ordinates at the level of the rational head. Now, in alliance of the lecture room, we can all re-think the rational co-ordinates of the Third at the same level of Rabelais's text. Together we can display the head of another by fragmenting it against some extraordinary realignments:

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So positioned, the once noble head can be subject to the grotesque cartwheeling cycle. Where once Rabelais turned the body's inner organs upside down, we can now transfer this act onto the new dimensions. First, the contents of the head are wound round and around: addled addled- brain balderdash head not screwed on muddle-headed mixed-up stir-crazy wind-up* wound-up From here we can make the site of selfhood migrate from its coordinates: amok astray away with the fairies bearings (lost one's) boat (missed the) gone (really)* gone away she lives out where the bus doesn't go anymore home (no one at) not knowing if coming or going rambling round the bend wandering We can make the irrational head perform in or out of a proper standing: does not have the sense to come in out of the rain out in the rain too long out of her head out of her mind out of it out to lunch out of order out of touch in a stew in a bad mood in the doldrums in cloud cuckoo land in never-never land in and out of control* in a flap burned-out flipped-out freak-out far-out spaced-out stressed-out way- out zonked-out We can force the qualities of proportion up into the skies or down into the underworld: breaks down* calm them down* crawling up the wall* dippy clown and out* down in the dumps down in the doldrums flying head in the clouds he's going to go up!* high high as a kite hypedup keep him up * low over the top* settle down * the slippery slope through the roof* up the pole * up the wall uptight Or make the head on or off the given co-ordinates: off off her head* off their heads* off his rocker off his trolley off his tree going off in a big way* on the blink on the rocks of fat the deep end off the wall switching off* not getting on with it * Modern forms of global communication can only enrich and re-generate this colourful genre. Where once the site of the carnival was the principle meeting place of trade and the traveller now new systems of communication

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mean that the proportions of rationality can be juxtaposed against more or less anything. For Bakhtin the ‘conquest of the world [brings] the world closer to man, to his body, permitted him to touch and test every object, examine it from all sides, enter into it, turn it inside out, compare it to every phenomena’ :42 two sandwiches short of a picnic a quarter of a bubble out of plumb his belt doesn't go through all the loops two cans short of a six-pack steps don’t go all the way up to the attic yet to muster a full pack of huskies a kangaroo loose in the top paddock

DISCUSSION AND DIALOGUE But am I right to frame the activities of professional dialogue in so bleak a set of terms? Could it not be said that the subject itself is in fact trivial and certainly not weighty enough to merit any serious discussion, let alone a dialogue in public? Surely the subject matter of unofficial terminology is on no more of an intellectual level than those seaside mottoes pinned up on notice boards advising members of staff that it is helpful to be mad to work here. Amusing maybe, but as hackneyed as the words listed in this chapter, reflecting, at worse, lazy or perfunctory thinking habits. No one can deny that words play a central role in structuring the social formation and, yes, people do draw upon different registers to secure particular meanings. And if the occasional colloquialism plays a part alongside humour, laughter, smiles, teasing, and friendly physical contact: then so be it. There are many ways of softening the demanding tasks undertaken by a supportive clinical team and these words perhaps serve to relax the necessary constraints imposed by clinical practice. Even Bakhtin admits that when people relate to each other in friendly and familiar contexts, ‘the serious goals of language [become] dropped’,43 Such is the human condition. Is it not more the case that the real addressivity of the Care Chronotope is one directed from a dedicated fraternity towards the hundreds of people who are helped daily by the same practitioners symbolised by the composite figure of the Ringmaster? Their occasional lapses into low registers are no more representative of proper professional practice than are the unfortunate experiences recorded at Ely, Rampton and Whittingham hospitals. This is a strong voice indeed. A voice that is fully embodied in the unity of official language, well equipped with powerful terminological weapons and more than capable of warding off intruders. It is a pervasive voice too; a voice whose vibrant tones fills-in all the available space of official literature. I am not too surprised by this. After all, it is also a voice built by the heroic ideals of Karl Jaspers. Practitioners, he reminds us, must possess a sceptical

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suspicion in order that they may be prepared for encounters with the confusing aspects of reality. ‘Critical enquiry,’ he writes, ‘would rather know the limitations and possibilities. It wants a clear understanding of the boundaries and implications of each viewpoint and fact.’44 Within the intonations of this voice I do not have to listen for too long before coming to realise that this is language that does not communicate. By proudly declining to enter into dialogue with voices other than its own it becomes a voice that conceals or even hinders the potential for interaction. Its very unity of standing is dependent on the exclusion of peripheral voices. The Ringmaster stalks in the shadows of this voice and it is well accomplished in narrowing the options of dialogue and in the crafting of proper forms of speech. Those appropriate registers of speech he has spread out before us are the ones that conform to social and professional expectations. Allon White45 observed that official knowledge is knowledge encoded in high language. And, indeed it may well be difficult to take seriously one who voices opinions in non-standard ways. But the fact remains that the explanatory superiority of high registers remains unproved. The flavouring of a voice with a classical style does no more than add a persuasive appeal to official knowledge. It makes it all the more important that the polyphonic traveller is attuned to which component part of a voice contributes to understanding and which part adds only to its ornamentation. But in the end it is of little concern to a unitary language that other generic forms may be more adequate to the means of understanding. Built into every unitary language is the assumption that investigations can only be conducted within its own form of language. A language that acknowledges only itself and the object of its investigation carries the danger that the subject’s voice is devalued, muffled, reduced, made silent. So far my journeys have purposely privileged the marginal voice over more official discourse. And what the Ringmaster paraded before us were targets that were reduced to a lesser variable of ourselves. The subjects became, in Bakhtin’s terms, ‘mute objects, brute things, that do not reveal themselves in words, do not comment on themselves.’46 Once, between lectures, I accidentally opened a forbidden door in the clinic and wandered into what I discovered to be the senior consultant’s washroom. The soft lighting and the enormous floor to ceiling mirror impressed me. What was made available to me here was a flattering reflection quick to promote an illusion of completeness and control. In this illicit space I was offered the opportunity to rehearse a full range of classical postures. I took stock of myself and compared aspects of my body to a series of desires: taller or shorter, more or less, firmer or softer, older or younger. By projecting these dramas onto my reflection I was brought under the same controlling gaze that commit legions of other individuals to live

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their lives in ever on-going acts of comparison. But Bakhtin unsettles my narcissistic dialogue with the mirror. He tells me that I cannot be alone before a mirror. He allows that the image reflected before me can be embodied. If I stood more upright, straightened my tie, and smoothed my hair down then I could truly see myself as ‘a hero among other heroes.’47 But rather than turning the gaze inwards and into myself I learn that the reflection is not for me ‘butfor others through others’48 The mirror has been transformed into a medium of human relationship with another. The connection I have made between my inner self and what Bakhtin calls the ‘optical forgery’ of the mirror is really a dialogical link with another: a spouse, an employer, a colleague, a parent, and so on. Before the mirror I have summoned others to construct an image of myself. And, as I have seen repeatedly the power of the image on a collective screen, can fundamentally transform the nature of social encounter. Somewhat anxiously I left the washroom and returned to the collective proximity of a relationship to the unitary body. On the screen before us we can build fictions of ourselves. Together we can reinforce our grip and our hold in the shared knowledge of knowing where we stand in relation to the image on the screen. The surplus fears thatfalling apart can physically decentre the “me” by losing it all or letting myself go can be greatly reduced by aligning myself to the flesh of a larger body. Parts of the body do indeed disintegrate, rot, become lost, or are incapacitated, but only by way of a psychotic dialogue can a me choose to disseminate bodily components upon a fantastic screen. What we can do, and at a level of immediate comprehension, is to send other aberrant mental states to bounce with kangaroos, jump from trolleys, fly with kites or run with the huskies. We can take the bits and pieces of another consciousness and broadcast them beyond the limits of understanding. We have the full weight of rational authority to assign the Third to a region where ‘the dividing lines between objects and phenomena are drawn quite differently than in the prevailing picture of the world’ .49 As consummating co-authors we are allowed to connive in propelling another consciousness to Dolally or make it howl with the lunar cycles of the moon, ramble off round the bend, crawl up the wall or slide down the slippery slope. Together we can transport it up in the clouds and make it go round and round in circles so it does not know if it is coming or going. In an alliance of laughter you and I can mix-up this fruit cake and make it go haywire through its own hole-in-the-head, On the screen before us we can make its buttons go missing, or crack, shatter, or craze its shape in any form of weird, wild, or moonstruck mood we choose. Or we can just switch it off. In so abrupt a manner did the carnival once start and stop. The gap that divided the official from the unofficial was hardly to be glimpsed. The interlude separating one utterance from another is the province of a fleeting

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silence that harbours its own myriad potentials of response. In the wordworld of the psychiatric landscape unofficial terms leak out along the corridors of the clinic work to subvert the determination to possess a onesided language. As a genre it has its roots in the discarded practices of the carnival. Perhaps they are to be respected and even treasured. Earlier, I presented Michel Serres’s ideas on the medieval French word bruit that represents the social background noise of ‘the tumultuousness of things and rivalrous dissension among human beings’.50 Our modern timespace would remove this messy and human dimension, holding that when meanings become pushed beyond their representational domain, the screen will simply become noisy and switch itself off.

The words appended with an asterisk indicate their use in a lecture. The style of this chapter draws its influence from Rabelais’s practice of loading a text with lists of words. 2 RAHW: p421 3 ibid: p403 4 ibid: p163 5 ibid: p32 I 6 FTC: p170. 7 ibid: p33 8 Friedson, E., Profession of Medicine New York, Dodd, Mead & Company, (1970) 9 ibid: p61 10 RAHW: p29 11 Brooke, D., ‘The Addicted Doctor, Caring Professionals?’, in British Journal of Psychiatry, Vol. 166, (1995) pp149-53 12 Ely, Report of the Committee of Inquiry into Allegations of 111-Treatment and Other Irregularities at the Ely Hospital, Cardiff; (Chair: Howe, G.) HMSO. CMND 3975, March 1969, p402 l3 ibid: p463 14 ibid: p245 15 Griffiths, T., Comedians, London, Faber, (1976) p20 16 South Ockendon, Report of the Committee of Inquiry into South Ockendon Hospital, (Chair: Hampden-lnskip, J.), Parliamentary Papers, Session 6 March-20 September 1974, (14 May 1974) Vol. V., p114 17 MacDonald, M., Mystical Bedlam: Madness. Anxiety arid Healing in Seventeenth-Century England, Cambridge, Cambridge University Press, (1981) p123 18 Szasz, T.S., A Lexicon of Lunacy. Metaphoric Malady, Moral Responsibility and Psychiatry, New Brunswick, Transaction Publishers, (1993) p13 19 Spevack, M., A Shakespeare Thesaurus, Hildesheim, Georg Olms Verlag, (1993) 20 Neaman, J., Suggestion of the Devil: The Origins ofMadness, New York, Anchor, (I 975) 21 Willeford, W., The Fool and His Sceptre: A Study of Clowns and Jesters and their Audience, Baltimore, Northwestern University Press, (1969) p11 22 DiN: p281 23 SG: pp1-9 24 DiN: p293 25 SG: p4 26 RAHW: p432 1

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cited in Clare, A,. Psychiatry in Dissent, London, Tavistock, (1980) p94 Kraupl-Taylor. F., Psychopathology, London, Heineman, ( 1979) p80 29 Mayer-Gross, W., Slater, W. and Ross, M., Clinical Psychiatry, Edinburgh, Bailiere, (1977) p137 30 DSM IV., Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, American Psychiatric Association, (I 994) p418 31 Berrios, G.E., ‘Obsessional disorders during the nineteenth century: terminological and classifactory issues’, in The Anatomy of Madness. Vol. 1, eds. Bynan, W.F., Porter, R. and Shepherd, M., London, Tavistock, (1985) pl66 32 Ryklin, M. K., ‘Bodies of Terror: Theses Toward a Logic of Violence’, in New Literary History, Vol. 24, (1993) pp5 1-74 33 Report of the Review of Rampton Hospital, (Chair: Sir J. Boynton), HMSO., CMND 8073., Department of Social Security. (1980) p18.2.3 34 Palmer, J., Taking Humour Seriously, London, Routledge, (1 994) p20 35 Morson, G.S., ‘Parody, History and Metaparody’, in Rewriting Bakhtin, eds. Morson, G.S. and Emerson, C.. Evanston, Northwestern University Press, (1989) p65 36 SG: p99 37 Joki, I., Mamet, Bakhtin and the Dramatic: The Demotic as a Variable of Addressivity, Abo, Abo Akademi University Press, (1993) p40 38 Freud, S., Jokes and their Relation to the Unconscious, Vol. 6, Harmondsworth, The Penguin Freud Library, (1976) p144 39 SG: p99 40 Report of the Committee of Inquiry into Whittingham Hospital, (Chair: Payne, R.), HMSO. CMND 4861, 1971-2 Session, XVI, (1971) p17 41 FTC: p170 42 RAHW: p381 43 ibid. p422 44 Jaspers. J. General Psychopathology, p42 45 White, A., Carnival, Hysteria and Writing: Collected Essays and Autobiography, London, Clarendon Press, (I 993) pl33 46 DiN: p35 1 47 AA: p31 48 ibid: p33 49 RAHW: p421 50 see Assad, M. L., (1991) p278 27 28

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Chapter Five

Encounters with the Grotesque

The carnival attitude promises joyous renewal but may well deliver something less desirable as well. David K. Danow1 The two previous chapters have revealed the limitations of confronting psychiatry with its own official voice. For the most part the polyphonic traveller declines to engage with face-to-face liaison preferring, particularly with facades as powerful as psychiatry, a position that is alongside a given voice. Travellers will need to adopt the guises of itinerancy and learn to take on standings that are held together by the forces of cunning deceptions. So prepared the traveller is free to wander on the landscape, stumbling up against obstacles, at liberty to wander in and along the corridors of the clinic, or to sit for hours if necessary in the day rooms and waiting areas. Polyphony gives new sight lines on the entry and exit points of the clinic. The traveller is forced to work out, minute by minute, novel contextual bearings on all the regions of no-man's-land that are otherwise so difficult to claim. Many of these regions are in a wilderness where the unitary voice is reluctant to stray into half-recognising that there may be other dialects in which its own voice will count for little. The polyphonic traveller is to be found loitering around this distorted ecology aimlessly entering into dialogues that are gained by simply being by another voice. It is a map substantially different than the one seen by those who continue to make heroic efforts to compel this land into some sort of order. 97

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One of the features of travelling polyphonically is the possibility of sudden encounters with the grotesque. The nature of these encounters is the subject of this chapter. I will argue that it is not necessarily the spectacle of this figure that is important but the quality of the traveller’s response. After giving some account of the grotesque I will go on to propose aprimary and a secondary relational response. Both positions are guided by different chronotopes. It is safe to assume that the translation of these responses into practise will not be problem free and, therefore, in Chapter Six, I will extend the idea of the grotesque against a model of madness. And from there onwards I am free to take further step-downs into the landscape.

THE DISTRACTIONS OF SEEKING GROTESQUE DEFINITION Manifestations of this life refer not to the isolated biological individual, not to the private, egotistic “economic man,” but to the collective ancestral body of all the people. M. M. Bakhtin2 It is an exasperating exercise attempting to define something that refuses to submit to a single position in time and space. For the official voice the structure of a relationship to the grotesque presents a particular problem. The grotesque challenges all long-standing presumptions that an object of study should be content to remain still while it is examined. The grotesque is a highly promiscuous subject. At first it appears entirely free with its favours, but before the examiner can confirm their own standing the relationship seems to collapse and the promises the grotesque has offered are transferred elsewhere. Under these conditions whatever methods of study are used must first begin by acknowledging a mobility that skips, mischievously or maliciously, from one sense of meaning to another. To one side of the attempt to understand the grotesque is the running subtext of the conflict between a modem selfhood and a much older collective identity. This argument is at least four hundred years old and Bakhtin’s opinion can be found in his scathing opinions on Romanticism. Romanticism, he argues, was fully responsible for appropriating the grotesque as an oppositional and symbolic figure to counter the dominance of rational logic. The grotesque was made into a focus of fear and fascination as it was made to wander around the modem imagination as an alien and sinister plaything. Bakhtin is also eager to link Romantic thinking

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with the psychoanalytical shaping of the modem self. Freud’s study of the Uncanny 3 transferred Romanticism’s aesthetics of horror into the interior intrapsychic conflicts of the individual. He used the grotesque as a representative of the unconscious in a way that discounted all of grotesque’s ancient functions. So well has Freud equipped the twentieth century with the idea of the unconscious that it is difficult to unthink a modem subjectivity without this benchmark of selfhood. This conviction allowed Freud to claim that the uncanny effects experienced when we come across the unfamiliar are due to the return of repressed infantile experiences. The fear that is felt stems from the flooding of our consciousness by memories that are stored unconsciously. We learn that the factors shaping this response is dependent upon an individual and infantile ‘original emotional reaction to death’ or upon the ‘insufficiency of our scientific knowledge’.4 Yet in the Ringmaster’s parade of the unfamiliar we had an audience well schooled in a sufficiency of scientific knowledge. Our raucous reaction and communal laughter that greeted the display of the uncanny would question Freud’s notion of a universal oedipal experience. In contrast to Freud, Bakhtin is only prepared to consider the grotesque in an embodied and social form. He forcibly defends a figure that has been stolen from its ancient communal roots and transferred into the private and interiorised domain of the modem self. Bakhtin is adamant in reminding modernity that grotesque’s legacy is anchored in a social setting that was central to carnival logic. As a figure it was fixed to the beliefs of folkculture and it took on all the life-giving and life-taking aspects of the Material Bodily Sphere. As a living representative of this world the grotesque displays its embodied form and whatever it’s wild, exaggerated, or hybrid appearance it is always recognisably human. Because carnival logic is always directed towards the renewal of its objects of celebration Bakhtin promotes the grotesque as a socially positive force. In its ability to free ‘human consciousness, thought and imagination for new potentialities’5 Bakhtin moves the grotesque into an almost euphoric level of analysis: rationality folds into the irrational, the body expands into the fantastic, and there is an abundance of collective celebration. At all points of social transition the grotesque figure of carnival consciousness is on hand to unhinge the collective consciousness from its drab and mundane routines. There are always moments in the social calendar when the progress of linear development is interrupted by interludes of sheer irrationality. In this turbulent timespace the figure of the grotesque emerges amidst the clamour of the collective body. In his Uncanny essay, Freud suggested that encounters with the fragmented body – ‘dismembered limbs, a severed head, a hand cut off from the wrist’6 – produced an uncanny feeling in the individual that sprang from a repressed ‘castration complex.’ Like Bakhtin I

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find it hard to be persuaded by this individualised relationship to the grotesque. The more compelling explanation is to be seen in the refamiliarisation of the grotesque as it appears in the transitional aspects of the social body. For example there were many spaces outside of the lecture rooms where the students rehearsed the construction of their body away from the guiding gaze of the Ringmaster. These spaces were exclusively the province of the student collective body and here the issues of transformation emerged through the medium of grotesque in a way that could not be imposed by the Ringmaster. In the interludes of linear progression the grotesque figure is never far removed from the anxieties of transition. I offer two examples to illustrate the presence of the grotesque in the social transition of the student body. In his book Body Myths,7 the medical anthropologist, Cecil Helman, recalls visiting a medical school’s dissecting room. He describes the groups of medical students clustered around the stone anatomy slabs and the low murmur of Latinised commentary echoing off the tiled walls. Anatomy assistants come and go carrying specimens on white enamel plates. ‘A nose, lying alone on the plate like a triangular snail. An ear juxtaposed with an ankle. A hand and a spleen, sharing a plate.’ Suddenly, turning into an alcove, Helman interrupts a group of students engrossed in a grotesque activity: ‘Someone plays cricket with a disembodied arm and a rolled-up handkerchief, but no one keeps his score, and the game quickly dies.’8 If this seems too extreme consider Phil Hammond’s9 experience at a Birmingham Medical School and the connections his observations have with carnival practices. He relates a clever ploy whereby new students were duped into revealing intimate secrets about their sexual attitudes. Within hours, noticeboards throughout the school were resplendent with the same information attached to photographs of the hapless students. Hammond goes on to describe a variety of end-of-term dinners, where, amidst wild bouts of drinking, spoof awards are made that range from the ‘Person of the opposite sex you would most like to catheterise,’ the ‘Most self-talked about Phallus’, to the ‘Singularly most irritating Christian in the year.’ On these sections of the landscape Rabelais, I am certain, would feel perfectly at home. Rabelais, himself a physician, worked on the threshold of two very different worlds, and his writings dis lay the collective body in all its ‘grotesque and fragmented aspects.’10 Locked into the forbidden sanctums of these student assemblies are all the unofficial activities of the body in transition. Multiple voices are to be heard converging in the context of this timespace. Physical, emotional, and sexual functions are wildly spread out and made to fuse with other forms of meaning. Within the student body, the standing of individuals, as if at random, are subjected to unsettling assaults. Personal beliefs are mocked,

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intimate secrets are exposed and made public, and everything that is linked to the individual is pulled down into the Material Bodily Sphere. It is at these communal points of transition that the grotesque voice comes alive. Blood is made to flow in its veins and its living presence becomes the connecting medium of the social body. Its voice, of course, is a makeshift one. The grotesque presence is short -lived and ephemeral. Just as suddenly as it starts it stops and moves on with a promiscuous indifference. Bakhtin tied the figure of grotesque logic to the metaphor of a moving ‘cartwheel.’11 He built this trope from the grotesque body's sense of movement that retained the connections of upper and lower realms of meaning. Equally he borrowed the images of the clown and the tumbler from the carnival. Their rotational activities – buttocks flipping over to be replaced by a face – had the same symbolic meaning of a downward movement towards earth and an upward movement towards the heavens. Agrarian cycles of time - the life-giving spring replacing the life-taking winter - work in the same manner. The effect of cartwheel circularity denies the polarities of the high and the low as oppositions and re-codes their relationship as a rotating process. So when a student found himself or herself to be the victim of some prank the object of the exercise was not to assign their standing to some negative static void. It was more the case that the cartwheel had immersed their body into a lower sphere of conception, and in an on-going process, had shifted their standing onto a renewed, perhaps even stronger, footing. The cartwheel can only move on. In a perpetual replacement of the top by the bottom it has no single level of meaning. As one aspect of the wheel moves around a different but connected roll of energy moves in a contradictory direction. And as it moves the exposure of different surfaces are revealed that are on the threshold of the inside, the outside, and the upside-down. Highly contemptuous towards all the fears of the ordered world the grotesque knows it can mock and laugh in the face of earthly terrors. In the temporality of a sudden threshold encounter the grotesque invites the student body to absorb the immensity of these fears and to consume and conquer them in laughter. In this embrace the student body is taken away from a customary timespace and madefree to engage in creating a more positive standing. The certainty of the ordered world takes no comfort from being dipped into the ambivalence and contradictions of the Material Bodily Sphere. A timespace that displays simultaneous acts of dying and becoming finds an uneasy accommodation with the demands of linear systems of organisation. Grotesque's hybrid qualities combine, in a single image, seemingly incompatible attributes. Hybrid juxtapositions – animal and human, male and female, the fart at the case conference – all unsettle commonplace

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binaries yet always offer the potential of a renewed understanding. To the awe-struck witnesses the hybrid figure of the grotesque provokes and reaches out into their own familiar domain. Exaggerated orifices, protuberances, and bodily emissions are in themselves connections with an outer social space. And as an aperture of social exchange, the displayed grotesque orifice teasingly offers itself outwards as a boundary phenomena on the point of intersection with another. No less than any other living form, the grotesque needs the response of the other to function properly. As an enterprise the unitary body has generally been successful in denying the temporal presence of the grotesque has alien or nonsensical. It has been triumphant in dividing and separating the imagery of hybrid juxtapositions into positive and negative segments. Bakhtin, ever lamenting the fragmentation of the body, sees in the rise of the private individual a corresponding negation of the once regenerating lower bodily strata.12 The dual quality of humanity, so blatant and exposed in the grotesque, has been cleaved apart, leaving the downward dying drive as a static and unconnected force. Modernity has built for itself a temporal convention that is forever switched into a fast-forward mode. It has constructed a way of life that is often indifferent to the interests of anyone other than a dominant generation. Old age becomes removed from youth, death from birth, the mad from the sane, and the ailing from the living. The grotesque has been colonised into a region where its own ambivalence is denied. It was necessary to tame the grotesque and make it static in order for it to become a marker for a modem identity. In effect, the cartwheel was halted. A segment of the wheel was harnessed and allocated as a region of exclusion where all of grotesque’s disorders and discomforts could be contained with new weightings of disability, abnormality, or the pathological. A specific quadrant of the cartwheel had been domesticated and its inhabitants forced to mark time pending some future assessment. In the meantime, grotesque protuberances could be smoothed down, hybrid outbursts could be tranquillised, and alarming encounters manoeuvred back from the edge of irrational threshold. New official definitions were manufactured by linking human experience to a pathological disease. Control was exercised by imposing an officialfinishedness on the body of the other and a measure of social relief was obtained. From the idea of a halted cartwheel the act of enhancing one image at the expense of weakening the sense of the other is given flesh. The overseers who must manage this settlement are given licence to convert the other’s imagery into nosological rankings of pathology.

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MRS DRYDEN’S PEAR To develop properly the workings of polyphony requires that any abstract considerations be periodically submitted to encounters with the more material levels of meaning. As a traveller in this mode it is my responsibility to demonstrate a readiness to consider the potentials available not merely to a theoretical resolution but in their prosaic ramifications as well. A characteristic of polyphony is that instead of drawing knowledge in towards a centre of understanding it promotes the projection of knowledge outwards towards meeting points far removed from an authorial centre. In doing this polyphony is not simply mimicking or extending the didactic technique of employing everyday examples to enhance an argument but is asking something considerably more elemental. By fraternising with a wide range of voices the traveller is considerably more open to participating fully in unexpected encounter. Such dialogues are discovered only through the traveller’s efforts to disregard those pre-conditions that remove the potentials of surprise and suddenness. Earlier, in the jolly japes of the medical students. I was able to encounter some surprising activities. But along the officially designated routes of the clinic such startling encounters are few, or are hidden, or they are made invisible. I want to make a brief step-down by considering the mouth as the leading image of the grotesque face.13 Bakhtin’s reading of Rabelais observes that the gaping mouth was once universally recognised as a symbol of the allconsuming unfinishedness of the collective body. Rabelais relishes in Lucifer’s image of Hell as having gates constructed by broken teeth within a gaping mouth. In the symbolism of ancient folk culture wide-open jaws represented the commencement of a swallowing death. The mouth was the start of a rotational process that devoured and expelled matter onto a fertilising earth. It is possible to weaken the engagement with this imagery and step back from its impact if we are determined to view its symbolism as a lost Gothic narrative. To the classical eye Rabelais’s gaping mouth is imagery that elicits a singular response of disgust or tastelessness. It is imagery that is hard to swallow or difficult to stomach. The neo-classical standing prefers that the mouth is closed and quiet in consumption, moderate and considerate in its sounds, and its teeth, as revealed in the polite smile, are white and clean and even. Like other bodily fluids, the emissions of the mouth are expected to stay in their proper place. But to be suddenly confronted by the gross image of the mouth and its connection with death is to find oneself in a position that cannot be stepped back from. The following is an extract from the Inquiry into Ely Hospital:

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When the wife of the late Dryden [a psychiatric in-patient] was visiting him and wished to feed him a pear, she asked a female member of the nursing staff to obtain his dentures. The nurse returned with a bowl containing a number of dentures, mixed up together, and proceeded, by trial and error, to fit some into the patient’s mouth [...], the nurse in question, also tried to fit into the patient’s mouth a set of teeth which she had removedfrom the mouth of a sleeping patient, and “rinsed under the tap.” It also seems likely that she did indeed explain to the family that most of the dentures in the communal bowl “belonged to dead patients.”14 My response on first reading this incident is still impressed upon my memory. I felt alarmed and horrified, even ashamed and angry at the conduct of the practitioner. But I also confess to an outburst of outrageous laughter. Tucked away in a corner of some godforsaken hospital I had stumbled across the provocations of the grotesque. What was being enacted at Mr Dryden’s bedside was a dialogue resplendent with all the images of Rabelais’s gaping mouths and impending deaths. Mixed in to the spectacle was the communal bowl of alien teeth, the re-generative hopes of Mrs Dryden’s pear, the authority of the nurse’s standing, and the background structure of the hospital itself. In the space of a few seconds a whole ragbag of contradictory polarities were jumbled up with my own wildly mobile emotions. Fear, bewilderment, anger, and laughter danced alongside the underlying motifs of death and renewal. As I read these voices I had reacted immediately. My fascination and disgust was accompanied by a malicious laughter. Confronted by the ambivalence of the scene my own inner confusion was pulled into a strange but mutual reality. I had been taken in by the grip of the grotesque hybrid and I had entered, as it were, into the same body. But I make the point that this event is to be understood as something more than my own response. I will argue that there is value to be gained by going on to consider a primary and a secondary position in a relationship to the grotesque.

THE PRIMARY POSITION I begin with the sweeping proposition that in my fleeting experience of disgust and laughter I had re-captured an echo of my roots in the primordial order of things. For a single instant my status of a modern selfhood had been abruptly relegated to a primitive and collective unity. I had been returned to a Dionysian chorus line incapable of distinguishing the

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performers from the participants. In Bakhtinian terms, the footlights had been removed and the audience had merged onto the stage. In the same way that I came across the unofficial practices of the medical students the spectacle at Mr Dryden’s bedside had been an encounter I was unprepared for. I found myself in a region of meaning where the division between self and other was compounded into a participatory activity outside of which no other life was possible.15 I had been dragged, irresistibly, into an ambivalent dance were promiscuous interminglings were wedded to outrageous responses. Almost contagiously I had entered a manner of an interrelationship where it is not possible to react passively to the events unfolding around me. I was fully engaged in this reciprocal performance yet I knew, instinctively, that without the shared activity of laughter, fear, and proximity, the energy maintaining the encounter could not be held. Once I was enrolled in this setting I began to tread a delicate balance between the activities of creativity and destructiveness, value and worthlessness, and even terror and care. The laughter I contributed to these events was conducted in the inverse of what would otherwise be recognised as socially appropriate. The neat and organised sense of control, the composure of the classical body, was abandoned as the most unyielding of human qualities – lust, hostility, greed – were pulled into the encounter. What became available in this sudden intersection of voices is the potential (another opportunity, another reminder, and another faint echo) to view the world again in a new and re-conceived form. Just for the briefest of instance; I was in a world with the strongest reciprocated connections to the Material Bodily Sphere; a time and a space that gives up its grace and its terrors voluntarily. It is a world, reminds Bakhtin, that is ‘given to me’ in a unique here-and-now formula:

For my participative act-performing consciousness, this world, as an architectonic whole. is arranged around me as around that sole center from which my deed issues or comes ,forth: I come upon this world, in as much as I come forth or issue from within myself in my performed act or deed of seeing, of thinking, of practical doing.16 The grotesque thrives on surprise and the unexpected. The encounter that I came upon set in motion a dance that fully engaged my emotional and physical performance. Submerged by the primitive unity of a collective body I could only participate in all the ambivalent aspects that issued from an ancient connection between humanity and its environs. The primary position is thus characterised by a full participatory and incarnated encounter.

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THE SECONDARY POSITION On offer, of course, is a retreat to the secondary position. As much as anyone else I am free to decamp with haste from this confusing encounter and make a connection with the gravitational pull of a unitary voice that guarantees me a personal distance. However, in the terminology of market forces, I must pay rent for this position. The price, a high one, is calculated by the degree of allegiance I make to the collective security of this body. The protection the secondary position offers in return are those of distance and security. Distance, because as I withdraw from the discomforting encounter the power of its imagery becomes diminished. Security, because the conceptual confusions that so threatened me can now be separated out into inanageable categories. Accordingly, the energy I invested in removing myself from the encounter has resulted in a lessening of the earlier tension. By taking myself away from this mode of interaction I have calibrated a specific distance from the grotesque voice. It follows that the exact location of this distance will determine the style of all my future relationships. The same dialogic formula repeats itself. In making the object of my consideration conform to a secondary frame of reference I am equally justifying my own standing. From the secondary position the temptation is to impose the security of a larger bodies ideas onto the truth of an encounter. From this vantage point I am free to enhance the intensity of difference between myself and the grotesque. Ideally, this difference works to the extent in which I am neatly here, and they, the other, are over there. So profound is the severance of relationship that the body of the other is made fully passive. Ultimately the unity of grotesque logic is lost to the body of my newly claimed consciousness. Too easily the whole of the grotesque image is taken over by whatever modified perceptions I choose to impose.

DISCUSSION AND DIALOGUE Progress, after all, is simply progress toward the positive and away from the negative Ken Wilber17 So what is taking place in the suddenness of grotesque encounter that evokes so strong an emotional and physical confusion? In what way are these lived experiences so radically modified by secondary evaluations? Can it be that so much energy is consumed in the intensity of the reality that the encounter itself comes to be denied? The ability of a body to make

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surrounding activities invisible to itself would seem a necessary attendant upon the ordered life. Again I am reminded of the evidence of the witness at the Ely inquiry: ‘One lives,’ she said,’ with a situation so long that one no longer sees it.’18 George Steiner recalled that as soon as the Second War was over: ‘Germans in every walk of life began declaring that they had not known about the atrocities of the Nazi regime.’19 Yet everyone will know that the acts and responses depicted in the event actually occurred. I know that I responded with disgust and laughter to the events surrounding Mrs Dryden’s pear. In truth, so fascinated is the classical body with the spectacle of the grotesque that it is prepared to undergo great risks in order to satisfy the craving. But if it is questioned it will deny or radically modify such base motives. As example, motorway traffic police regularly complain of motorists recklessly abandoning their concentration in order to give full witness the aftermath of road traffic accidents. The way drivers strain their necks to see the carnage has earned the practice the term of rubbernecking. The police complain that drivers put themselves and others at considerable risk in pursuit of satisfying their curiosity. But this phenomena of our highways can be taken further. As if in a reciprocal exchange with the image of autopsia the rubbernecker’s eyes will pop, their stomach will turn, and their mouths gape in wonder. These gruesome scenes mesmerise the spectator and evoke simultaneous feelings of horror and fascination. Whatever the spectacle the position of the spectator is built on a sense of a human sharing. The feelings generated by this proximity can often place the encounter as a main life event, a dramatic point of a spectator’s biography. At a sensual level the experience of the primary position feeds the spectator with a sense of activity. The experience of the primary position gives scope for exploration, something that will excite all the bodily senses. Sometimes the ordered world can suddenly collapse and everyone will make a temporal alliance with collective passions. There are times when we can’t retreat to a secondary position. Indeed we may not wish to. A yearning for the intensity of collective passions is sometimes captured in political rallies or on the football terraces. The crowd is a strange animal. It carries values of its own, quite unlike the values of the mere individuals that make it up. In modern day remnants of carnival practices – often at the threshold of a world vanishing and a world arriving – the most surprising modes of relationship are conjured up. This is R.D. Laing: I have seen catatonic patients who hardly make a move or utter a word, or seem to notice or care about anyone or anything around them year in andyear out, smile, laugh, shake hands, wish someone ‘a guid New Year’ and eve dance [...] and then by the afternoon or evening or next morning revert to their listless apathy.20

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The Care Chronotope, in the main, is committed to the idea that the resolution of problems will be found within the boundaries of the body, What takes place between bodies is an avenue of inquiry largely obscured by abstract narratives that favour genetics, pharmacological, or electrical solutions. Over and over, the practitioner body is advised to step back from the thresholds of human confrontation and adopt the classical attribute of a detached ‘imperturbability.’21 The secondary position is the natural habitat for the professional body. It allows for the appropriate measure of detachment and control in the face of the unfamiliar. The stark implications of these values are not easily articulated in today’s mode of liberal humanism. In the lecture rooms I felt it was much easier for everyone if the Ringmaster articulated the values of emotional and physical detachment through the dynamics of humour. Quite the most effective punch lines were those delivered in an emotionally neutral voice. The closure of a joke always expressed the triumph of the adept unaided by any recourse to an emotional involvement. My premise makes the point that the more we seek solutions in the secondary frame of reference the more the events of the primary position are made distant, the more they are made passive and insignificant. It is the hallmark of the Care Chronotope that it has sought to control binary opposites – the sane and the insane, the rational and the irrational – by an allegiance to the dominant arm of the duality. The colonising of the grotesque life cycle may well prove to be one further deviation from humanities dependency upon Mother Earth’s cosmic life-plot; a scheme designed to embrace all and everything. But my observations must not be taken as an extension to the school of anti-psychiatry. Anti-psychiatry is the most exhausting of options: the headlong leap into the irrational world is a bold venture but one ultimately detrimental to dialogue. Dialogue requires at least two forms of consciousness in order that it may prosper. The empathic merging of one consciousness into another may well have occasional uses but in any extended sense it surrenders the uniqueness of each participant. Bakhtin’s concept of outsidedness is central to the workings of dialogism. But it is, as I will show, a position to be firmly distinguished from the imperturbable detachment so familiar to the secondary position.

ALIBIS AND RESPONSIBILITY In Orthodoxy, however, it is not merely the answers that are different – the questions themselves are not the same as in the West. Timothy Ware22

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In any attempt to isolate the features of the grotesque, surprise and unexpectedness are recurrent preoccupations, so is instability, promiscuity, mobility, furtiveness, novelty, and circularity. The grotesque is a living and breathing entity, a phenomena in which human qualities can always be seen. Within one single frame of imagery the grotesque simultaneously displays incompatible qualities that are highly suggestive of novel forms of relationship. Gathering together grotesque’s leading properties in this fashion does less to explain what it is but more to say how it works. And this is how it should be. As a polyphonic traveller I have no control over the grotesque as a passive object of my gaze. I am not empowered to isolate anything as a lifeless object of study. There is no compulsion upon me to resolve problems of closure or definition. I can only try, respectfully, to live alongside it. And if I can’t I can only move on. At this point a further ingredient can be added to polyphony. There are obvious problems associated with the extremes of the primary and the secondary position. In the former the self-reflexive qualities of selfhood are rapidly drained away while the latter can impose a sterile conservatism upon its inhabitants. Both positions appear to commit the participant to conflict or confrontation. Polyphony must offer the traveller an escape from both these reactive forces. It must volunteer an ingredient that discounts a lasting empathy with the irrational but at the same time secure an outsideness independent of consensual forces. Bakhtin’s earliest work – the dense and fragmentary Towards a Philosophy of the Act – is the ideal framework to build on the concept of polyphony and at the same time refine the potentials and the limitations of the primary and secondary positions. In this short text Bakhtin suggests a different startingpoint to the one usually commenced upon by more rational approaches. He begins by contrasting experiential events (the personal acts of life) against the way that they have been undercut by the dominance of non-experiential means of representation (the various systems of abstract evaluation). According to Bakhtin, modernity’s need to convert experiences into a theoretical structure ultimately fails the immediacy of the live, minute by minute, act. Contemporary man feels sure of himself, feels well-off and clear-headed, where he is himself essentially and fundamentally not present in the autonomous world of a domain of culture and its immanent law of creation. But he feels unsure of himself, feels destitute and deficient in understanding, where he has to do with himself, where he is the center from which answerable acts or deeds issue, in actual and once-recurrent life That is, we act confidently only when we do so not as ourselves, but us those possessed by the immanent necessity of the meaning of some domain of culture.23

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Bakhtin’s observation is representative of the position of the practitioner on the psychiatric landscape. It is a characteristic of the Care Chronotope that the practitioner is permitted to act confidently within the orbit of different ‘domains of culture.’ Professional disciplines are arranged, like the fields on the asylum farm, into hierarchies of compartments, in which the standings of practitioners are cultivated by codes of practices, procedures, audits, and regulations, which are all, in turn, linked to the ticking clock of a unitary language. Proper practice becomes a matter of knowing these abstract values and implementing them into the act of clinical encounter. In Bakhtin’s terms, practitioners can be seen as being pulled between their allegiances towards a unitary explanation and the potentials that form the unique reality of lived events. To occupy a position of confidence on this landscape underlines the assertion that observation can only be conducted amid a sense of reason and seriousness. Already built-in to the Care Chronotope is the dictate that practitioners must live by set of approved norms. Psychiatry not only takes on a language construed around accurate description and compassion but also comes to embody a specific philosophy. Again, the price for this standing of confidence is a high one. Any position that mutually smoothes the neo-classical body also diminishes the potential for a creative understanding of the lived events of an encounter. Those who decide to live in the shadows of the statuesque carry with them Bakhtin’s alibis-for-living.’24 And those who choose to live by alibis are at risk of becoming ‘pretenders’, those bodies who ‘live in no particular place at all or from a purely generalized, abstract place.’25 As a basis of observation on human experience, the representations of others, shaped by ‘alibis-forliving’, may not only be misleading but dangerously evasive of the rich complexities of lived events. In suggesting this novel starting point Bakhtin is almost reversing the trend of modern hermeneutics. The alibis of theoretical reasoning, he urges, must become submerged into the act itself: ‘all that is theoretical or aesthetic must be determined as a constituent moment in the once-occurrent event of Being.’26 In other words, the practitioner must learn to lose their status as a spectator and become a participant in an organic connection to the lived events they stumble upon. Such events cannot be objectified and determined by abstract criteria. In the lived events of everyday life quite different levels of explanation are made available. But whatever form of analysis that arises from a lived event hardly meets with the unitary criteria of a linear and developmental chronotope. But in challenging so ruthlessly the theoretical structures that appear to overwhelm the contexts of events am I denying any value in the unity of the Care Chronotope? Am I not simply wading into the morass of relativism? The answer is that I am not. Bakhtin’s project is to house abstract evaluation

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within its own habitat. For him theoretical considerations are perfectly justifiable just as long as they are content to reside within their own boundaries. As soon as they begin leaking out onto the general landscape and begin to present their transcriptions as if they were acts themselves then they become guilty of ‘crude errors.’27 In identifying the boundaries of abstract considerations Bakhtin would ask of practitioners that they acknowledge the place of theoretical knowledge in everyday life by taking a responsibility for its use. In much the same way that current Health and Safety legislation requires practitioners to sign themselves in and sign themselves out of hospital premises so Bakhtin would argue that the visitor should ‘sign’ and evaluate a theoretical premise with their own ‘signature.’ Overall, the practitioner should take on the responsibility for temporarily inhabiting the body of an abstract construct. By choosing to live in the ‘flesh of another,’ and conducting a life by alibi, the practitioner can only live a life deemed to be proper by another body. The alternative is that practitioners become answerable to themselves and to other human beings. Bakhtin’s starting point begins with the event itself and only then the abstract. Such a sequence of activity would be a very different landscape indeed. In one way there would be a stronger sense of boundaries, but in another, the more formal procedures would be denied their previous status of taking the place of individual and collective considerations. I am at risk of assigning a personal set of ethics to the level of the heroic. But we are all blessed with an individual free will. God does not compel us to accept his grace. Ultimately, only my flesh and my blood that can transform a timespace into my uni ueness: ‘That which can be done by me can never be done by anyone else.’28 Bakhtin, as I understand him, gives us only glimpses of a dialogical landscape. Fyodor Dostoyevsky, Bakhtin’s principle influence, affirms the real intensity of a life lived and a life replete with unexpected thresholds of potential: [A]nd you supposed your cowardice was common sense, and comforted yourselves with the self-deception. [...] Look Harder! After all, we don’t know where ‘real life ’ is lived nowadays, or what it is, what name it goes by. Leave us to ourselves, without our books, and at once we get into a muddle and lose our way –we don’t know whose side to be on or where to give our allegiance, what to love and what to hate, what to respect and what to despise. We even find it difficult to be human beings, men with realflesh and blood of our own; we are ashamed of it, we think it a disgrace, and we are always striving to be some unprecedented kind of generalized h uman being. Fyodor Dostoyevsky29

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Danow, D.K., The Spirit of the Carnival: Magical Realism and the Grotesque, Lexington, The University Press of Kentucky, (1995) p34 2 RAHW: p19 3 Freud, S., ‘The Uncanny’ in Art and Literature, Harmondsworth, The Pelican Freud Library, (1985) 4 ibid: p364 5 ibid: p49 6 Freud, S., ‘The Uncanny’, p366 7 Helman. C., Body Myths, London, Chatto & Windus, (1 99 1) 8 ibid: pp1 15-6 9 Hammond, P., ‘You can’t beat medical students for tact and sensitivity: the ‘slag of the year’ award has now been ditched’, in The Independent, 11 June 1996. 10 FTC: p I 73. 11 RAHW: p353 12 ibid: p23 13 ibid: p3 17 l4 Report of the Committee of Inquiry into Allegations of ill-Treatment and Other Irregularities at the Ely Hospital, Cardiff, (1 969) pp5 1-3 15 RAHW: p82 16 TPA: p57 l7 Wilber, K., No Boundary: Eastern and Western Approaches to Personal Growth, Boston, New Science Library, (1981) p20 18 Ely Committee of Inquiry: p245 19 Steiner. G., Language arid Silence, Harmondsworth, Penguin, (1 967) p149 20 Laing, R.D., Wisdom, Madness and Folly, London, Macmillan, (1985) p29 21 de Swan, A,, The Management of Normality: Critical essays in Health and Welfare, London, Routledge, (1990) p 47. See also Rycroft, C., Viewpoints, London, The Hogarth Press, (1991) p50. Rycroft tightens this concept for psychiatry. Each culture, he says, must ‘invent a class of people [...] whose job it is to remain undismayed by those phenomena which do not fit into category-systems.’ 22 Ware, T., The Orthodox Church, Harmondsworth, Penguin, (1983) p9 23 TPA: pp20-1 24 ibid: p43 25 Morson, G.S. and Emerson, C. Rethinking Bakhtin: Extensions and Challenges, Evanston, Northwestern University Press, (1989) p19 26 ibid: p2 27ibid: p1 1 28 ibid: p40 29 Dostoyevsky, F., Notes from Underground, London, Penguin Classics, (1 972) p123. 1

Chapter Six

Madness and the Grotesque Chronotope

The crisis consists precisely in the fact that the old is dying, and the new cannot be born; in this interregnum a great variety of symptoms appear. Antonio Gramsci1 In this chapter I intend to abstain from the standard clinical approach to mental illness. Instead of using established formats of understanding and explanation I will employ the grotesque themes of suddenness and circularity as a working medium. The advantage to be gained by refracting a psychotic episode through the grotesque chronotope is that it opens up different potentials of dialogue. This level of meaning, it should be said, is only achieved by surrendering the means that cushion traditional forms of clinical relationship. Accordingly I have no licence to call upon the protection afforded by the professional body. I take full responsibility for this decision. It just means that in order to respond to the contexts of events I must clothe myself in a different changing room within the clinic. Running through this chapter, as always, is the intention to further extend polyphony’s range. A process is being rehearsed, one that will prepare me to step out onto a wilder landscape. My choice of using R. D. Laing’s A Ten Day Voyage2 is guided by the fact that it is the most notable of modem psychotic narratives. Laing’s essay is put together by an interview with Jessie Watkins, a sculptor and one-time naval officer, who entered into a psychotic state, was admitted to a clinic, and then returned back to his work and home. Of interest to the polyphonic traveller is Laing’s proposal, in the figure of the practitioner, of a changed relationship to madness, and in turn, to the psychiatric landscape 113

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itself. His portrayal of the practitioner as a journey partner is suggestive of a new spatial relationship between people. After all, there are well-recorded risks involved in embarking upon single-handed voyages. If the dangers cannot actually be lessened they can at least be shared in the company of another. The idea would appear to be of benefit to the voyager but as an embodied clinical relationship it is clearly outside the remit of approved clinical practice. R. D. Laing was one of the most influential and controversial psychiatrists of this century. His books sold by the millions and his message gave hope to legions of people who felt themselves trapped in a harsh and unfeeling culture. But the first victim of Laing’s philosophy was his own standing within the professional body. So hostile was mainstream criticism towards Laing that calls for his removal from the General Register became a regular feature of official censure. Demands that he should go and trade under the reputation of another discipline came from every quarter of the official cannon: If Laing wishes to he a guru or a philosopher, there is no doubt a place for him, but young people who are suffering from schizophrenia may prefer to entrust themselves to a doctor who will treat their illness as best he can.3 Laing was equally condemned for his own personal failings. His misadventures with drugs and alcohol eventually led to his being struck off the medical register.4 There are salutary lessons to be learned from Laing for anyone who contemplates wandering away from the more ordered pathways. His challenging utterances were supported by a visibly altered concrete component because he often lived among the mad whose way of viewing the world he so ably advocated. Laing was guilty of straying away from the footholds offered by a parent body and no self-satisfied institution welcomes a reformer, a revolutionary, or a messiah. Laing’s voice at times was a bit of all three. Like every voice that lives on the threshold Laing left himself open to embittered grapeshot reactions from his colleagues. Naturally some of this bitterness hit home. Like the temples of old Judea, psychiatry has never lacked its guardians, well clothed in unyielding ‘alibis-for-living’, and too ready to express alarm or concern when patients are offered respite by the wrong techniques. Contained in the voice of Doctor Mathis, a character in the nineteenth century drama, L ’Amour Medicin, is a truism recognisable on the psychiatric landscape: ‘It is better to die through following the rules than to recover through violating them.’ Bakhtin’s observations on the threshold symbols of everyday objects are a useful introduction to Watkins’s journey. Doorways, stairways, and entrances enable a body to pass from one timespace to another but their

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structure contains the potential of transforming hell or paradise into each other in a single instance.5 This sense of movement through things is important because Watkin’s uses the vivid metaphors of a sea voyage to give meaning to his narrative. His voyage into madness commences ‘suddenly’ as he crosses the borders of one timespace into another: ‘I suddenly felt as if time was going back [. . .] the greatest feeling I had at that moment was of time going backwards.’ He is in the grip of an inescapable downward slide: ‘as if I was slipping along and sliding down a – shute as it were and – er – unable to stop myself.’ In this accelerated descent Watkins encounters the grotesque in two ways. In both cases the imagery of the grotesque is prominent: the estrangement, the reciprocated ambiguity, and the sense of embodied rotation. The first thing Watkins does is to seek out a mirror in his own home: ‘I seemed as though I were looking at someone who – someone who was familiar but – er – very strange and different from myself.’ In Bakhtin we have the claim that before the mirror we are never alone. At least one other voice stands by us as an image is jointly authored. But here the voice accompanying Watkins belongs to the grotesque alone and he is caught up in a frightful primary position. There are no other voices to deflect the power of this imagery. At this point he is desperately alone. Laing: One sees the old and the familiar in a new and strange way. Often as though for the first time. One ’s old moorings are lost. One goes back in time.6 His second encounter with the grotesque takes on a more social aspect as Watkins is admitted to an observation ward. He is still locked into the primary position, still responding to the rotational and sudden shifts of the grotesque. He endures his first night in the clinic as ‘an appalling sort of experience.’ Not only did he feel he actually died but all the other patients had died too. Everyone, he feels, is ‘just waiting to pass on to the next department.’ In this transitional, primary position, the grotesque entices its captive into the no-man’s-land that divides the Care and the Patient Chronotope. ‘At one time I actually seemed to be wandering in a kind of landscape [...] as if I were an animal [...] It sounds absurd to say so but I felt I were a kind of rhinoceros or something like that and emitting sounds like a rhinoceros and being at the same time afraid and at the same time being aggressive and on guard’7 In this most turbulent of mid-zones new experiences of time and space are encountered. Everyday objects take on a quite different perspective. Timespace stretches or shrinks to give novel and unfamiliar meanings. The

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nurses on the ward give him newspapers to read. It proves an impossible task. Headlines now carry ‘very much wider’ associations than he would have previously expected. ‘Everything’ has a ‘very much greater significance than normally.’ A letter from his wife contains phrases – ‘the sun is shining here’, ‘it’s a nice day.’ To Watkins, these simple phrases have different spatial meanings altogether. As Watkin’s relates his story to Laing he delves deeper into the metaphors of the seafarer. He combines and compares his psychosis with his first voyage as a raw sixteen-year-old midshipman. In freezing Arctic waters his ship is buffeted by a series of extraordinary storms. Waves crash across the ship, the galley is washed out, the ship rolls horribly, and there is a constant danger of shipwreck. He is terrified by the events he is imprisoned by and at first he does not believe he can survive the voyage. On board the ship and on the ward he feels the same sense of a total individual vulnerability. As the impact of the storm and the psychosis are encountered his body appears to change: ‘I was too soft [...] It’s as if something soft were dropped into a bag of nails.’ As a youngster his relationship to the rest of the ship’s crew is remote and unrelated to any of his private feelings: ‘They gave me no sympathy, you had no sympathy from anybody.’ Watkins finds himself embroiled in a timespace that has a profound effect on the nature of human relationship. In chronotopic terms he is being pulled into a sudden and enforced time and he is a part of an inescapable movement through space. Under these conditions new and different chronotopes are called upon to provide a different set of human imagery. From now on those voices that are favourable to individuality are quite secondary. In the urgency of this timespace any call for sympathy or claims upon inner private concerns would only detract from the immediacy of the mission. Clearly Watkin’s survival is dependent on a successful transition from a private inner dialogue to one that fits a public expression.

DISCOVERED FELLOWSHIP The stronger, the more organized, the more differentiated the collective in which an individual orients himself, the more vivid and complex his inner world will be. V.N. Volosinov8 In this narrative the tension between the private and the public self takes on a new relevance. Bakhtin’s commentaries on the Hellenistic public have

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a direct bearing on Watkins’s movements with this tension. Bakhtin shows that in various civic ceremonies the lives of individuals and social events were made fully public. Every aspect of the Greek city-state – art, science, its deeds, its good and its bad fortune -were to be made visible before all the people. The same display applied to the standing of the individual. They too stood had to stand before everyone: ‘open on all sides, [. . .] all surface.’9 In the ancient public square there were no platforms that offered an individual development. Roles in the city-state-the soldier, the farmer, and the artisan – were firmly laid down. It was for the individual to fill-in the space of these roles, to the acclaim or otherwise, of the public square. On board his ship Watkins relates how he fumbled towards filling-in the role of a midshipman. As the storm progresses he begins to ‘stand up’ to the conditions of the voyage. He tests out the qualities required of him by ‘pretending to be brave.’ Throughout the storm it is impossible not to see a group of individuals acting out life alongside each other. Their destiny and their sheer survival are dependent on an interactive and co-operative purpose. Commands and regulation (alibis) have their proper place but the overriding understanding is to a personal response (responsibility) to an event shared by all. Under these appalling conditions timespace is intensified and human imagery must fill-in, or more properly, live-into an immediate relationship to otherness. For the young Watkins bravery is to be gleaned from the fellowship of others. By filling-in this role he takes on the full public expression of this quality. Watkin’s narrative is rich in the symbolism of grotesque activity. He speaks of moving in different temporal directions and of living in an another kind of spatial dimension. He describes coming into contact with a host of fantastic events. He moves through the stages of death and renewal as if he is part of a huge cartwheeling process. In the end it is his voice which decides that he must leave the cartwheel. He achieves this by forcing upon himself a renewed standing in the ordered world. Determined not to go down, not to ‘go under’ again, he refuses any further medication and enters into a new dialogue. And, as at the beginning, his return is registered by a changed pace in time. The storm suddenly abates: And so I sat on the bed and I held my hands together, and as – I suppose in a clumsy way of linking myself up with my present self, I kept on saying my own name over and over again and all of a sudden, just like that – I suddenly realised that it was all over. All the experiences were finished, and it was a dramatic – a dramatic ending to it all.10 Laing’s conclusions to Watkins’s journey directly challenged psychiatry’s ability to manage madness. For Laing, Watkins’s return to safer shores was made possible only by the fact that he received comparatively

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mild forms of sedation and he held that psychiatry’s therapeutic interventions had the effect of interfering with the natural process of a journey. He questioned the value of the psychiatric clinic as being the most appropriate environment for a psychotic episode to be experienced. Recovery, he implied, takes place independently of the clinic’s avowed intentions, and much more provocatively, Laing challenged the usefulness of psychiatrists and the validity of their treatments. At the time these were – indeed still are – dangerous statements. He was writing at a time when radicals everywhere were questioning the certainties of the Western canon. Anti-psychiatry was one of many movements that unsettled the direction of a New perceptions of society, induced or otherwise, post-war recovery. suggested that human relationships could be rediscovered through the medium of love. This is an old message but the air of the late 60’s was fragrant as this, and many similar themes, flowered for almost a decade. Laing was certainly a leading figure in this revolution and the impact of his voice shook the ordered boundaries of psychiatry more than any development since the demise of moral therapy. The theme I want to amplify in Watkins’s narrative is the quality he found in the journey partners aboard his ship. As a model for a relationship it is at variance with every official system of care. There is little evidence of personal empathy or of any attempt to understand the needs of the individual. The keyword, although neither Laing nor Watkins use it, is that the journey partners are there alongside him throughout the most unsettled phases of his voyage. Watkins’s safe return from his voyage was entirely dependent upon his standing within this discovered fellowship. Outside of this community, Watkins as an individual, could not survive. It is true that other people enter and exit the flow of Watkins’s narrative. Laing’s voice is present and so to are the officers commanding the ship, the doctor and the nurses who manage the clinic, and his own worried wife. But these voices only receive an acknowledgement as distant and secondary figures. They are voices whose intentions lie with a different timespace, namely, that Watkins is returned by ordered means to a state of recovery. Undeniably, Watkins’s draws upon the communality of the ship’s crew as being the most beneficial voice. In his middle years and long after the sea voyage is over he finds himself again in danger of falling and going under so he reawakens a long-closed off dialogue. Re-called from another timespace his shipmates are again willing to assist him at the lowest point of his misfortune. I find it useful to itemise and retain the qualities of Watkins’s discovered fellowship for my own journeys ahead: a) The journey partners, the crew, were alongside each other in body and spirit.

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b) Mutual trust was earned through the public expression of the body. c) All were involved in the temporary suspension of hierarchical values. d) The private concerns of individuals were of minor consequence. e) The interdependence of the whole vessel, the environment, the crew, carried a primacy of value to the task in hand. My point of departure from Laing is with his drift into romantic primitivism. He takes the impact of Watkins’s voyage and compares it to those ancient pilgrimages undertaken by individual mystics. No lessons are to be drawn from the social implications of the ship’s crew. Laing is seeking heroes. Maybe even beginning here his own eventual journey to the eastern mysticism. But back in the ordered world Laing’s charismatic personality was increasingly being pulled into adversarial positions with mainstream psychiatry. Overall, he underestimated the power of the official canon and the loyalty of its disciplines. He was indifferent to the defining ability of unitary languages to overwhelm and stratify lesser ideologies. For psychiatry the practice of intervention and the desire to be in control of human messiness are self-evident functions. As a disciplinary body the Care Chronotope is fated to continue its ambition to re-align disorganised temporal dimensions back onto the measured pace of linear time. These regions of encroaching wilderness, rather than being left to organise themselves, are to be brought into the range of the asylum clock and carefully cultivated. Laing’s central contribution to psychiatry was to point out the harm it was doing to the people it purported to help. I claim no universal application to psychotic texts. Of course, Watkins’s voyage is open to a diversity of interpreting voices. For instance, various forms of regression analysis – guided returns to earlier levels of functioning – would recognise the cyclical process of a dying-transition-rebirth format leading to a re-integration of selfhood. Practitioners of this discipline would argue that Watkins, at his lowest level of regression, and having no words to recount his condition, resorts to the imagery of a braying animal.11 Alternatively, there are parallels to be seen in the brief enthusiasm for therapeutic communities that developed at Belmont Hospital after the war.12 For the psychiatric landscape this all-in-it-together melieu is probably the closest model to Watkins’s ship. But the resemblance is only artificial. The crew aboard Watkins’s ship was taken up by a chronotope marked by a living urgency and an interdependent desire for survival. Any ship that provided full board and medication and encouraged its crew to play with each other’s thoughts would hardly survive the high seas. In both of these approaches the fact remains that there is no escape from the gaze of the analyst or from a voice with strong institutional obligations. The quality of Watkins relationship to others was of a very different standard. In the

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fellowship he discovered aboard ship he gained a footing within a collective locked into a total timespace. He became a member of a crew that had a real investment in a mutual desire of outcome. Embraced by the sheer terror of the sea they had no option but to live-through what life threw at them. A storm is a storm and it can be lived-through positively or negatively. Like the inhabitants of the old city-state the crew faced together the fortunes and the misfortunes of everyday life. It is to the power of grotesque logic to escape from both the primary and secondary positions in that there is always temporary licence to suddenly stop and laugh into the eye of the storm. Renewed footholds are secured and the storm’s life-threatening power is briefly made insignificant. For polyphony there are important questions to be asked from Watkins’s narrative. What amount of inner and individual concerns must be discarded in order to diminish the anxieties of unfolding events? What form does being alongside another actually entail? If it is not sufficient to rely on objective stances of detachment then what must be taken on in order to meet polyphony’s potential? At this stage it is clear that polyphony is to be represented in a living and social setting: a relationship to another that takes on flesh. Like shipmates in a storm polyphony sees only a fleeting value in committing one’s own consciousness into an empathic relationship with another. Neither is it enough to depend upon a neutral and licensed alibi-forliving. Such a remit removes life of its uniqueness and all its risk-taking potential. And herein lies the starting point of polyphony because it only guarantees to take the traveller to the threshold of an encounter and it builds and creates rather than seeking to unfathom underlying causes. It begins by positioning itself on a landscape that recognises different levels of registers, different dimensions of now, and the presence of unofficial fellowships. And it proceeds by transcending rational and irrational voices and acknowledging the form-shaping capacities of official and unofficial genres. In order to advance polyphony further is will be necessary to add flesh to its present abstract sense. I intend to do this by continuing the process of stepdowns onto the more material levels of the psychiatric landscape. It would be naïve for me to assume that the following chapters could be allowed to speak for themselves without some form of analytical outsideness. Nonetheless, the following narratives purposely unsettle the balance of the abstract to the lived event.

Gramsci, A,, Selections from the Prison Notebooks London, Lawrence & Wishart, (1971) Laing, R.D., The Politics of Experience, Harmondsworth, Penguin, (1967) 3 Siegler, M., Osmond, H. and Mann, H., ‘Laing’s Models of madness’, in Laing and AntiPsychiatry, eds. Boyers, R. and Orrill, R., Harmondsworth, Penguin, (1972) p121 1

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At the suggestion of the General Medical Council Laing resigned from the register on the 26th February 1987. The council where pursuing a complaint of drunkenness and misbehaviour but there seems little doubt that his ideas on psychiatry where highly unpopular in the official realms. See Clay, J., R.D. Laing: A Divided Self; London, Sceptre, (1996) p241 5 TRDB: p299 6 Laing, R.D., The Politics of Experience, p122. 7 ibid: p123. 8 MPL: p88 9 FTC: p136 10 Laing, R.D., The Politics of Experience, p131. 11 see Symington, N., The Analytic Experience: Lectures from the Tavistock, London, Free Association, (1986) p294. 12 Jones, M., Social Psychiatry, a Study of Therapeutic Communities, London, Tavistock, (1 952). According to David Smail, these communities represented ‘an intolerable challenge to a hierarchical NHS bureaucracy’. Smail, D., How To Survive Without Psychotherapy. London, Constable, ( 1996) pl0. 4

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Chapter Seven The Practitioner Patients

We [patients] had met by chance. We would probably never see each other again. But the meeting, while it lasted, was elemental and profound – an unspoken, shared understanding and sympathy. Indeed, for the most part, our speech was light. Everything, on the surface, was merry and light. An outsider would have thought us a frivolous lot, overhearing our conversation. But its lightness, our lightness, covered profound depths. [...] If we were frivolous, it was the high spirits of the newborn – and equally, of those who known the deepest darkness. But none of this would have been seen by an outsider. Oliver Sacks1 There is a hazy and indistinct patch of the psychiatric landscape where the edges of the Patient Chronotope and the Care Chronotope collapse into each other. So cloudy is this region that those who choose to peer into its interior can barely see the characters that wander there. My task, in this chapter, is to follow the contour line where these two chronotopes come together and make contact with mental health practitioners whose mental states are severe enough to warrant their transfer from one timespace to another. All of the practitioners I am to meet underwent a period of clinical depression or anxiety and almost all were admitted and treated in a psychiatric clinic. Skilled in the arts of the unitary domain, these practitioners were called upon to step down from the heights of their parent body and enter into a much less prestigious settlement. For the most part my encounters are taken from a re-reading of their experiences that were brought together in a book designed to provoke the concern of mental health 123

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workers: Wounded Healers: Mental Health Workers ’ Experiences of Depression.2 A collective overview of these voices suggests three areas of interest. Firstly, these narratives confirm that the trajectories of the Patient and Care Chronotopes are on entirely different planes: the conception and experience of mental illness are strikingly different. Secondly, a preference for unofficial styles of narration is preferred to convey the integrity of their experiences. Although their narratives are addressed towards a professional audience the practitioner patients choose to disregard the official word. At many stages in their illness these new patients are in conflict with official ideologies. Thirdly, nearly everyone reports that everyday objects are perceived in a distorted or altered fashion. This latter observation puts us back in contact with Watkins’s relationship to the clinic and his own recovery. Of the twenty-one practitioners I encounter, some fourteen emphasise the importance that groups of people played in mediating the transition from downward to upward time. All of these groups were unconnected to the practitioner patients at the time of the onset of their illness. And, as it was for Watkins, people already known to the practitioner – families and friends – are present in the narrative but the power of their influence hardly matches that of their new comrades. For the most part the groups fit into the criteria of a discoveredfellowship: a group of others to be sought and arrived upon by the patient. Two thirds of the practitioners recall being drawn into the comforting bodies of women’s groups, prayer meetings, or new employment settings, while in particular, groups of fellow patients are identified as the most beneficial facilitators of transition. In only a small number of reports are recoveries (and by recovery I mean a move into upward time, the glimpse of a light at the end of the tunnel) accounted for by official interventions: drugs, ECT, or psychotherapy. A second feature of the newly arrived patient lies in the strong connection with the minutia of everyday life. Otherwise ordinary items suddenly take on an intensive quality of relationship. Practitioners recall being immersed in a bodily stillness and the need to grip or to hold onto objects that lie within the immediate vicinity. They can sit for hours gripping on to the arm of a chair or they stare endlessly at the shape of an electrical socket. During this downward stage an individual solitariness enables inner and circular thoughts to degrade and propel the body towards its lowest point. Thoughts are described as going around and around. But at the point at which the practitioner begins to move into the territory of patienthood a different concentration on the environment becomes evident. Everyday milestones of meals and the comings and goings of others take on an accelerated significance. As Oliver Sacks indicates at the start of this

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chapter much of the general conversation of patients appears trivial to the outsider. But there is a purpose to this chatter in that it rolls along with the circular thinking of patienthood. So much of patient time is filled-in with talking about or around the potentials of action. In this ever-circling dialogue truths can be tested and activities can be rehearsed. Somehow the dialogue suffuses and complements the inner utterances of the individual and eventually assists in moving and making new connections with an outer world. Thirdly, it is notable that these accounts are exclusively expressed in the register of everyday language. Practitioners, presumably skilled in the use of the official word, resort to an everyday vocabulary to relate their experiences. It would appear that the official voice of objective observation and reason is one that is discarded upon leaving the Care Chronotope. In a region where a prolonged circularity of dialogue is prominent the constraints of a unitary language appear inadequate to articulate a bodily connection to the more material levels of understanding. The practitioner’s preference for the everyday voice can be witnessed in the choice of titles they assign to their essays. All but two titles call upon the wisdom contained in the cartwheel’s rotational process.

Dying, downward time Hitting Rock Bottom In the Wilderness Wading through Mud Big ‘D’ From the Brink A Kind of Termination Through a Glass Darkly View from the bottom There won’t be a next time It couldn’t happen to me – could it?

Upward, regenerative time Awakenings Surviving Depression Hope is the Key Looking Back Learning to Live Beginning to Live scare me anymore

Metamorphis Life doesn’t

PRIMARY AND SECONDARY POSITIONS OF THE CARE CHRONOTOPE I will begin with the reminder that the heroic-classical body is a body endowed with the strength to minister to the sick and the vulnerable. It is a body capable of walking among the disabled with the countenance of a compassionate imperturbability. For one of its numbers to weaken is to corrupt this smoothed-down bodily profile. Accordingly, there are useful

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insights to be made in observing the reaction of practitioners faced by the fall of a colleague. Most practitioner patients’ record a similar sense of feeling distanced and nudged away from the communality of everyday clinical reality. As a collective body the practitioner patient is diminished and becomes barely perceptible in the hazy regions of this landscape. This position was brought home to the Clinical Psychologist who wrote about his experiences in Wading through Mud. Diagnosed with depression he is offered treatment as an outpatient while continuing to work in his own department. Within his own place of work he quickly comes to experience the judgmental and detached aspect of his colleagues. His words are acutely sensitive to an uncomfortable professional confusion trying to come to terms with a leaking profile: The fact that I was surrounded by people whose principal professional concerns was the understanding and amelioration of psychological disorders was an additional and bizarre twist to the experience. I felt rather like a goldfish in a glass bowl. But actually, although it is unfair to make such generalizations, I felt the predominant reaction was embarrassment, resulting in avoidance or denial.3 Awakenings, written by a Consultant Psychiatrist, wishes desperately that the social confusion of his depression could be magically transformed into a straightforward physical ailment. His sense of isolation is captured in the awkward rationalisations of his absent colleagues: When the dreaded plague strikes at a doctor’s house, the rest put up their shutters and circulate the comforting notion that the victim’s illness is the direct consequence of the sterling qualities possessed by every member of the caring professions: an excess of virtue, ifyou like, turning upon its owner like a two-edged sword.4 And for the Occupational Therapist (It couldn ’t happen to me – could it?), returning to work after an episode of post-natal depression, finds that her previous grade has been downgraded ‘for my own good.’ During her absence her position had been ‘reassessed’ and it was decided to transfer her to the less prestigious region of managing long-stay patients. Her demotion is a bitter experience and she finds ‘it very enlightening to study the reaction of my colleagues. In some cases, I found it very disturbing that someone who had worked for so many years in psychiatry was so inept at dealing with me.’5 A somewhat different experience occurs to the author of In the Wilderness. On admission to a psychiatric clinic he is ‘overwhelmed’ by the number of colleagues who come to visit him. Too ill to manage this parade of spectators he asks for some respite. What is of interest is the high

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judgmental content of his fellow professional’s comments: “you of all people”; “everyone at the hospital is amazed that you have had a breakdown”; “you’ve studied too much, you were never up to it”; “I’m not surprised, I always thought you had a weakness, you were far too proud”; “What are you going to do now? You can’t ever nurse again.” These remarks identify a collective vulnerability and are descriptive of the alarming possibilities of a fragmenting classical body. Their words are also an example of how one body can be reduced to the status of a spectacle and of how effective some utterances become in serving to string a set of footlights around an object of study. Following his discharge, the practitioner returns to his hospital only to find the foregoing attitudes compounded into an official reception: ‘The Head of Nursing told me I had behaved disgracefully and let the hospital down and everyone in it and what the hell did I think I was playing at.’6 Such hostility to the practitioner patients may be extreme but not uncommon. Often it depends on the practitioner’s status in the order of things as to the manner of the pronouncement but there is no doubt that the feelings of vulnerability and shame enflesh the bodies of the fallen practitioners. It should be noted that nearly all the practitioner patients chose to publish their experiences anonymously. They are caught in a selffulfilling position of at once being made insignificant yet wanting in themselves to be invisible to the gaze of the other. A recent MIND survey7 on discrimination against nurses with current or past histories of mental illness throws more light on this subject. Observing that many nurses felt they had to lie about their psychiatric history to ensure a chance of employment, the survey echoes the same conclusions as the practitioner patients: ‘Its ironical that people in nursing with a mental health problem are unable to be open about it.’ But even within the more progressive employment practices of mental health charities the combination of a mental health problem and a paid position is equally strained with difficulties. Alison Faulkener and Liz Sayce – two people in this position – commit themselves to disclosing their history but recognise it as an option that has ‘real, life-damaging effects.’ At base are their own fears about appearing incompetent and of the impact upon their colleagues if they began to disclose events concerned with over-dosing or an involvement with the police. Faulkener and Sayce share the same insight as the practitioner patient’s: In mental health services, workers are at least as concerned about discussing mental distress as in other organizations, if not more so. It is deeply ironic that professionals who expouse the centrality of users’ views are working in a culture which effectively silences them.8

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The wafer-thin vulnerability and feelings of failure only reinforce the experience of being shunted out towards and eventually across the margins of professional competence. And it is always at the edges of the Care Chronotope that these reactions are most clearly drawn. The nature of this boundary event is emphasised by a Psychiatric Social Worker who became depressed. At the beginning of her illness she felt shame and, unable to talk to her colleagues, she notes that no one seemed to notice her falling performance. ‘I’ve often thought since then,’ she writes, ‘that although we tend to be tolerant and understanding towards our clients, we put pressure on our colleagues to keep to the right side of the boundary between helper and client.’9 In sum, the foregoing observations can be seen in parallel with the separating practices of the spectacle of cartwheel imagery. In halting the grotesque process a segment of meaning has been isolated and made to perform to rational conditions of practice. The same pattern repeats itself. Negative aspects are emphasised in order that positive forces may flourish. The body of psychiatry expels from its remit those forces that appear to undermine its own standing. Any practitioner who falls into a depressive cycle unsettles the professional persona of propriety and capability. And it is the surrender of rational attributes that lead to a sense of shame and incompetence in the practitioner: ‘I found that becoming a psychiatric patient was a step taken not only with intellectual reservations, but also with a huge sense of failure and shame.’10 In the terms of the cartwheel process, it as if the high embodied ideals of official standing must, at all costs, be prevented from being dragged down to a material level. Those practitioners who fall from expectations find themselves rapidly expelled from the security of a familiar profile to be left alone in a brittle and very hazy noman’s-land.

NO-MAN’S LAND In the Care Chronotope the rapid flow of time casts its flotsam out onto the margins of its liability with the same force of energy it uses to maintain its own integrity. Practitioner patients feel stranded and left to the mercy of dangerous and unknown forces. As was the case with Jessie Watkins this desolate territory is ripe for encounters with grotesque imagery. Practitioners find themselves stumbling up against quite fearful events: ‘After admission formalities, I was allocated a bed in a dormitory, and on my first night was terrified to find myself securely locked in with 11 other ‘crazy’ women, and no staff.’ 11 In another admission, an Occupational Therapist describes a similar encounter: ‘Very little of those first few days

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make sense. [. . .] I was unable to distinguish reality and I tried to rationalize conversations and countless terrifying noises I heard beyond the curtains of the bed.’ 12 It is unnerving to be in no-man’s-land and particularly if one is confused or just plain scared. What further complicates the experience is in the suddenness of arrival. ‘It started one night with a clear, and sudden onset,’ recalls the Clinical Psychologist in Big D. ‘There was no prior warning of what was to happen, or would continue to happen over the years.’13 The Consultant Psychiatrist remembers the same sense of suddenness with a striking precision: ‘at precisely five o’clock I awoke into a world that had changed, and to a state of mind of which I had no previous experience.’14 A Senior Social Worker is suddenly removed from the familiarity of an ordered timespace: ‘I was girding my lions to get back to the fight when the crisis occurred.’15 And, in ‘an appalling sense of disorder and panic’ a Health Visitor’s world suddenly ‘began to collapse around my ears.’16 All in all, this is territory whose timespace is painfully discontinuous with that available in the official world. Various attempts to adapt or to seek control over a new environment seem fraught with difficulties. One way of coping with the estrangement is made in desperate bids to cling onto previous values of compliance and regulation: ‘I wanted so much to conform but I didn’t understand the rules and regulations.’17 An anonymous doctor, writing in the British Journal of Psychiatry’s Bulletin, makes an almost pitiful call to the world he was only recently a significant member of: The desire to please, to talk about the right things in the ward round, to feel the treatment is helping, and above all not to be any trouble to anyone, is probably likely to be felt more intensely by a psychiatrist patient than anyone.18 Steven Hughes, a practising surgeon, and one of the few to actually give his name to a narrative, is determined to make some sense out of no-man’sland. His essay, Inside Madness,19 is an angry account of a man crashing between the boundaries of two separate chronotopes. Admitted to a clinic with a delayed post-traumatic stress disorder following the Falklands war, he finds himself abandoned in a confusing world. ‘Who are the minders,’ he demands to know on his admission, ‘and who are the minded?’ He is urgent in his resolve to cling on to the vestiges of the classical body and he takes a profound comfort from the appearance of the admitting psychiatrist: ‘He was dressed reassuringly in a collar and tie; he looked and spoke like a doctor.’ At one point his general practitioner calls in to the clinic and Hughes again gleans reassurance from the smooth profile of his visitor. ‘He was superb – prompt, professional, calm, and reassuring.’ Yet the detachment and the certainty exuded by his fellow doctors are of a different timespace and are

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unavailable to Hughes. Nonetheless, he makes continuous and heroic efforts to grip onto the borders of a chronotope that appears to offer him the most stable foothold. With considerable personal bravery he refuses any of the negative and passive components of the Patient Chronotope and persists in holding onto to the remnants of his old classical standing: I knew by now things had got out of control. I was no longer confident as a patient. If I was going to keep things together I had to assert myself. Thus I adopted my safe “doctor” persona again. It was no use playing ‘patient” because all that happened so far had served only to destabilise me.20 But not all are warriors. Most take on more cautious and timorous flesh. In this mid zone there is little that affords a comprehensible spatial value or a recognisable passage of time. A previous chronotope has been lost and the sheer loneliness of having to grope around in the haze of this endless marshland can seem to be overwhelming: Becoming an in-patient also exemplifies the patient’s perceived lack of control over his own life, as suddenly nothing is quite as it seemed and nothing can be relied upon with certainty anymore. At these times there seems nothing to hold onto, for the only thing that seems to be immutable is that the future will bring more pain and confusion.21

THROUGH THE GATES OF THE PATIENT CHRONOTOPE But entry to the Patient Chronotope must be undertaken. From the mire of no-man’s-land a pathway is eventually found that leads to the gates of a new order of timespace. At an uncertain intersection of adaptation, acceptance, and arrival, the practitioner patient comes to take on the voice of a new chronotope. The entry into the Patient Chronotope can best be described by its temporal and spatial markers. An Occupational Therapist confirms her acceptance of another system of time: ‘I was still disorientated with respect to time, believing that I was somehow not subject to the same laws of time as others outside the hospital.’22 And with a bitter sense of irony, Hughes, the ex-soldier, comes to realise that time really is different. ‘I was discovering that psychiatrists do not share the same time scale as other clinicians.’23 In addition, deference must be given to imposed time. This is the practice of one chronotope interpreting the value of a lesser timespace exclusively in the terms of its own set of meanings. Throughout the clinic the Care Chronotope makes efforts to impose a gentler model of its own busyness onto those it cares for. As a patient, a Clinical Psychologist

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discovered he was not ‘allowed to lie down during the day, [and was] hounded to meals and occupational therapy. ’24 And a psychiatric nurse remembered that the clinic’s occupational department worked from the principle that the ‘devil makes work for idle hands.’ She was much disheartened by the ‘coercive tactics’ used to get her to the sessions and she sympathised with other patients who referred to these staff as the ‘ Gestapo.’25 A foothold gained in the Patient Chronotope means that time becomes enfleshed with helplessness. ‘I was now one of them,’ observed a psychiatrist. ‘The whole business was about being a helpless “patient” – a passive, inert lump of problems, some of them intractable. ’26 Time begins to slow down. Patients discover that time is no longer a fast on-going stream but that it can suddenly start to congeal around deep and stagnant waters. ‘To endure this lingering state for weeks or months on end is totally indescribable. Minutes literally drag by. ’27 Elsewhere, on another clinic: ‘the days were endless. We waited around, sitting and lounging for drugs, meals, ECT, and doctor’s visits.’28 Slowly, this enfleshed time leaks out to embrace the surrounding environment: Ordinary objects were altered. Tables and chairs, or whatever it might he, now appeared as sinister, devoid offamiliarity, drained of the feeling formerly invested in them.29 Hughes, too, experiences strange perceptual concepts of spatiality. At times he is convinced he is about to ‘lose his grip’: I will never forget the bizarre fixations on inanimate objects as I tried desperately to divert my attention from the unhinging of my world – an electric socket, a patient trolley.30 It would seem sensible to make the body remain still in the face of these unfamiliar co-ordinates. And, indeed, some practitioner patients respond by gripping or holding onto anything that would appear to support their immobility. The psychiatrist: ‘I would grip anything within reach as though trying to derive warmth and comfort; or reassuring myself that something, at any rate. was real. I sat motionless for hours.’31 And an Occupational Therapist reported sitting rigidly ‘in a chair for hours, my hands gripping the arms.’32 These regions are silent pastures and they carry grazing rights for the grotesque. In this region the power of its shadow wanders at will. To stay still is a form of camouflage. To move is to risk coming under a dangerous surveillance. Everything that is other takes on the potential of a frightening encounter: When I was eventually allowed up I was subject to even more confusion. Ward staff resembled nurses from the hospital where I had worked but

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they didn’t recognise me. I got lost so frequently that I thought the rooms must be somehow changed or moved. I tried following other patients but they kept disappearing from sight.33 I want to give some further consideration to the stillness of the body in these narratives. It is important if only because the body is masking an inner dialogue that hides a contrasting system of movement. If we listen to the language being used the body is carrying an inner circular dialogue within itself. ‘Night after night, hour after hour [. . .] I was cut off from the world. Endless thoughts going round in circles, advancing nowhere.’34 Living less in the present and less in the future (for the future just appears as some bleak horizon) the mind buries itself in dialogues with previous betrayals and negative reconstructions of earlier injustices. Endlessly recycled, over and over, this is the beginning of the cartwheeling process that will eventually offer a renewed foothold to the sufferer. Stillness uses up lots of time but it gives a platform for the rehearsal of a series of inner dialogues. Even in this mire every word is unique to the one that has passed before. Slumped in a day room chair the Occupational Therapist is fully submerged in this activity: For two weeks I sat about the ward showing no initiative and doing nothing constructive towards my cure; my mind either blank or buzzing with thoughts which generally revolved around madness and badness.35 I suggest that what is developing in these circular ruminations are the first constructions of a healing dialogue. For now these inner dialogues are essentially private but eventually they will come to harmonise with a more public discourse. With every cycle the potential of a new space or a new direction painfully unfolds. The opportunity can be accepted, or refused, or postponed. In the meantime, this abject bodily stillness can be acknowledged as a token of entry into the Patient Chronotope: Once I accepted that this was what hospital was like, that this was the price I was prepared to pay for a kind of security, I became very calm. It was though I were in the eye of a whirlwind, very still, and watching the more or less devastating effects of the whirlwind on people about me, I felt so detached from this [...] This empty state was serenity for me.36

THE UNOFFICIAL LANDSCAPE It should really be an occasion for celebration but more often than not the conversion from one voice to another passes unnoticed. At some stage in the process of a revolving inner dialogue the practitioner patient arrives at an

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intersection where his or her private voice begins to make encounter with an outer, more public, stream of consciousness. Almost imperceptibly the individual voice is drawn into the wider orbit of the timeworn Patient Chronotope. It is here in this social union that a voice comes alive. Blood is made to flow in its veins and it is filled with new meaning as the patient come to inherit all the wisdom of those who have passed before. It is as if they have stumbled upon a clearing and have left behind them all the murky forest sounds of no-man’s-land. At this very moment they are open to all the possibilities of a new-found fellowship. Yet the region we are talking about was once a familiar landscape to the practitioner patient. As a patient it is suddenly very unfamiliar. A world that once seemed obvious is now alive with meaning and its own important codes of expression. What has happened is that the mad have been made to take on flesh and blood. In effect they have come alive. This is a collective insight on the part of the practitioner patients and I would stress that its import should not be seen in the light of an everyday observation. More, their voice approaches the realms of the revelatory as these new recruits to patienthood rebuild their conceptions in a renewed affirmation. Before I took up the status of “patient”, I used to think that I had an egalitarian, humane attitude towards patients, but the meaning I ascribed to becoming a patient myself suggests that actually I had seen patients as a race apart, incapable, helpless, andpitiful.37 Amongst my fellow patients I found much acceptance, companionship, and humour, and they greatly contributed towards my recovery. If I received, from the other patients more than I expected, I received from my psychiatrist less.38 Retrospectively I feel I have learned a lot in experiencing and coping with some degree of mental illness. If I had this illness before becoming a psychiatric nurse, I would have had a totally different attitude towards my patients.39 I have gained an insight into the predicament of those in the hands of doctors and nurses, which I could not possibly have obtained in any oth er way. 40 The surgeon, Stephen Hughes, in keeping with his military metaphors, almost seems to thrive in the opportunities that fellowship has opened up for him. ‘It was us against the system’, he recalls in a robust description of the relationship between the two chronotopes. He is sensitive enough to realise the creative and the destructive forces that are at work on this battlefield.

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But in the midst of this conflict he has yet to realise that the voice he is being pulled into will eventually come to soften his outrage and imprint upon him its wisdom of passive acceptance. Despite this, his position within the fellowship is built upon an acute understanding of his comrades: During the three days waiting to see the consultant I acquired something of an entourage of fellow patients. I found companionship and comfort and they found reassurance in knowing someone who knew the system. I found surprising talent and compassion besides the sadness and torment; many remarkable people with surprising abilities but temporarily lacking the capacity to cope with the world outside.41 But as well as inheriting a language the practitioner patients also become the victims of its ideology. In one of many sites unnoticed by the Care Chronotope an entirely different ethical system of regulation is found to exist. Here, everyday practices are guided by an accumulated means of unofficial knowledge designed to enhance comfort and or promote the general survival. A physician [Anon] quickly comes across a set of deceptive and subversive activities that unsettle his previous beliefs. He is shocked to find that patients exaggerate or deliberately lie about their symptoms in order to gain or deflect some aspect of treatment. His eyes are opened to the ways his newly found fellowship skilfully calibrates the limits of official medication. He is alarmed to observe that: 'non-compliance with medication was another area in which the actions of patients were influenced by others, and sometimes it was done with an ostentatiousness that begged discovery.’42 It is in the nature of the Patient Chronotope that all the topics of its life are frequently immersed through lower levels of meaning. The great cycle of the grotesque cartwheel is always in process and it comes as no surprise that many encounters in this neighbourhood are shot through with a prosaic and earthy dialogue. This is a world well outside the confines of official clinical space. More or less invisible, these outposts of dialogue continue to give voice to the living connections of a high rationality and the lower bodily strata. Otherwise unexceptional people became, as soon as they had stepped into our domain, veritable Falstaffs in the fullness and variety of their idiosyncrasies. There was a hugely obese Irish cleaning woman with a tongue as foul as the NCO's of my national service days. A bloated sendup of a Sean O'Casey character, she waddled about emitting an unbroken stream ofobscenities larded with Dublin slang. Then there was the nursing assistant, a dreamy, impractical girl who seemed merely to he tolerating her job because she could think of nothing else to do. She was attractive enough to interest men whose sex lives had been

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interrupted, and, conscious of her central position on our sad little stage, she played it for all that it was worth. A fragment of dialogue: Patient: “Be careful love, ifyou do that again we’ll all see your drawers. ”Nurse: “Never wear ‘em, dear, Not ‘igeenick. ’43 A less dramatic reason why so many subversive encounters pass by unnoticed is that these acts of transition are often so simple or gentle. A single fleeting moment of encounter is missed because its value is sealed in an ordinary act of humility. These tiny insignificant spaces belong only to the fellowship of patienthood and are outside the busy flow of linear timespace: That evening I allowed a nun, a fellow patient, to take me for a walk in the beautiful, park-like grounds. She was elderly and I helped her down the steps. I was surprised that no one stopped me.44 Within the slowed-down time of the Patient Chronotope there is ample space to articulate a genre constructed by an age-old wisdom. This fellowship is marked by an earthy comradeship;45 a gathering of others who often reach down into the lower levels of folk-belief systems to give meaning to the events unfolding around them. A Health Visitor makes an attempt to end his life. The act fails and he is resuscitated at a nearby accident and emergency department. During the return ambulance journey he recalls that he never felt ‘so completely abandoned or such despair.’ Yet it is from the everyday words of the ambulance men that he is made aware of the potentials available to the living. ‘You’ll be alright, mate,’ they chide, as they bump along in the back of an ambulance. ‘Every cloud has a silver lining. ’46 All this is not to deny that help cannot come from the Care Chronotope. It is just more likely to come from the manner of interaction and from individuals at unexpected points of the clinical hierarchy rather than from any official system of treatment. A Clinical Psychologist gains great comfort from a GP willing to support her own efforts to survive. He allows her to adjust her own medication and he seemed always more interested in ‘what was going right rather than what was going wrong.’47 The polyphonic traveller is in a unique position to enter into disregarded dialogues and from these voices they learn that practitioners who work from the qualities of listening and kindliness win the highest of accolades. Often it seems only to take these skills. Indeed, these self-same qualities are often taken back into a post-recovery employment. The suicidal Health Visitor, who on his recovery, went on to manage a busy clinic, states that his experience of patienthood had ‘mellowed’ his previous outlook. ‘I now consider other people. I try not to judge anymore, I have, I dare say, a fair measure of humility and I listen.’48 It seems ironic and even unnecessary that such a

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straightforward lesson was only to be learned from a grossly dangerous journey. But am I not correct to state that the Care Chronotope has long advocated the qualities of listening and understanding as the preferred method of all clinical interaction? These two human qualities are promoted repeatedly in the official literature. Jan Foudraine is one who has questioned this direction: Because one finds essentially the same suggestions (they have been turning up in the literature for years) I cannot escape the impression that there is something rather hopeless about them [suggestions involving improved levels of listening and empathy], that somehow, sadly, the hard core of the problem has been missed.49 The most significant aspects of official help were to come from unexpected individual acts. Officially, many of these acts stray close to what is permissible and what is not permissible. For it would seem necessary to unsettle the timespace of the Care Chronotope for these unofficial factors to unfold. As beneficial acts between a practitioner and a patient they are characterised by an inversion of official time, the unsettling of hierarchy, and the transgression of space. Such an awareness of the distortion of official timespace is contained in the statement of a Clinical Psychologist: From the less intense but more extensive support I received from colleagues andfriends, I’ve learnt how much more there is to surviving depression than the help, however invaluable, that can be provided through formal channels. 50 Most of the qualities of kindness that come from clinical practitioners are those that are invested with flesh. Often this help is of an unofficial kind and is to be seen in quite small acts of a willingness to step outside of the flow of official time: ‘during this time, my GP was a great support. I visited him weekly and he would just sit and let me talk.’51 Such temporal generosity is uncommon but where it does occur it is greatly appreciated. Identified in the GP is a commitment to a need clearly incompatible with the demands of official timespace. Yet there is another component that escapes official constraint. Often, this beneficial transgression is given by the influence of a member of the lower echelon of the clinical team. Practitioner patients attach an importance to their acts that is out of proportion to their place in the order of things. This is the dialogue that takes place in a deliberate slowing down of time and in a space where authority can be temporarily subverted. Quite simple events – marked by gentleness, quietude, or of bodily contact – are vividly recalled by the practitioner patients as acts of therapeutic significance: ‘a gentle nurse, not one of your brisk, jolly kind,

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thank goodness – who sat beside me like a mother.’52 Indeed, a number of these accounts recall encounters where the language of reason has not much value at all. It should be noted that these acts owe their value to the fact of someone simply being by another rather than in any face-to-face encounter. A Consultant Psychiatrist remembers a number of interactions where not only the manner of approach was different but also the members of staff were willing to transgress clinical timespace: One involved a light, encouraging touch on the arm by a psychiatrist, another was the preparedness of a night nurse to sit and talk and listen for a while, and the last was the gentle tearfulness of a young nurse after [my] suicide attempt.53 Again, this is not to further advocate the claim that practitioners need to address more closely the qualities of compassion and empathy. Certainly, it seems these attributes are appreciated more during the downward and solitary stages of depression. Indeed, when one is so raw and vulnerable no other form of contact may be tolerable. The power from the foregoing acts resides in their connection to the regenerative movement of the great cyclical process. Despite the static bodily depiction of depression the nature of these acts are closely tied to the renewing process of grotesque logic. And, as Bakhtin was to stress, the positive function of grotesque realism lies in its ability to free the consciousness of a body, to enable it to enter new areas of voice and of meaning.

DISCOVERED FELLOWSHIP Towards the end of his stay the physician, ‘Anon’, comes to realise that the ways in which patients influence each other is an ‘important variable’ he had been previously unaware of. The established tradition of assessing patients as individual cases rather than as being individuals who are part of a social group has long discouraged the Care Chronotope from giving attention to the virtues of shared suffering. In this sense, these narratives suggest that the primary therapeutic benefits of being hospitalised are to be gained from dialogues with fellow sufferers. As in the case of Jessie Watkins the members of staff only play a secondary or random role. ‘It seemed to me,’ observed the Consultant Psychiatrist. ‘That patients did more for one another than did the staff.’54 The voice of an emerging isolated body into the fellowship of others is a key nodal point in the cartwheel cycle. From the terrors of no-man’s-land, and through all the pains of authoring upon oneself a surplus of self-hatred, the passage into the proximity of others is a significant event. Grotesque

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logic, after all, works to free a consciousness to the possibilities of new modes of relationship. Accordingly, it should be emphasised that the discovered group is new to the practitioner patient’s biography. Although many practitioner patients do return to the Care Chronotope not one reports a direct transition back to a previous standing. In the transitional period most become involved with groups of others who all seem to share a subordinate relationship to the dominance of official organisations. For example, the Health Visitor finds a temporary position with a geriatric visiting service. Within this small supportive unit he feels free to relate his recent history. Elsewhere, a recovering GP attributes the prevention of an inevitable suicide to the love and the concern of a ‘Prayer and Share Group.’55 And in a process reminiscent of Bakhtin’s city-state, a Psychiatric Social Worker finds an enormous strength from within a woman’s group. The group shares all the intimate details of each other’s lives in a way that re-kindles the celebratory aspects of the collective body. This group of women possessed the ability of making blood run in each other’s veins: ‘We revelled in each others’ support and companionship. ’56 In sum, I have been able to view these experiences through the imagery of grotesque logic and a cluster of living chronotopes. I have seen how practitioners, unable to match the demands of a fast-moving temporality, suddenly found themselves cast off into a mid-zone of uncertainty. There they wandered, or even keep perfectly still, gripping on to whatever seemed to offer stability. In this mire the confidence to describe their experience in the security of the official word collapsed and they resorted to a more prosaic voice. Eventually, by the acceptance of a changed timespace, an entry point was found into the regions of the Patient Chronotope. As a polyphonic traveller I saw how the negative and downward process of depression was undertaken in a form of mute stillness. In this silent public posture many practitioners are engaged in a circular inner dialogue until another public voice signals the ending of this stage. From this point onwards the voice of the sufferer is absorbed into the orbit of a newly found fellowship. In attendance are the characteristics of prosaic simplicity and the more earthy forms of wisdom. Everyday terminology, folk systems of belief, and the comforts of companionship are qualities that practitioner patients make a respectful reference to. In dialogical terms, patienthood is governed within an arena where participants take on a collective responsibility for each other. In grotesque terms, a collaborative and regenerative activity is in constant motion. In carnival terms, unofficial practices are subverting a dominant regime. In Jessie Watkins’s terms, a storm is being weathered. But can I really argue that this process is outside the experience of depression itself! Is it not a fact that all the practitioner patients stressed the

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severity of depression as a wholly destructive illness? And is it not true that historical commentary has long noted melancholia’s singular engulfment of despair in the individual? Metaphors, both official and unofficial, have always expressed a downward force in their thinking about mental illnesses. Karl Jaspers referred to abnormal physic states as a lowering of mental capability - a ‘capitas diminutio – a lowering of the flag.’57 And Pierre Janet’s concept of abaissement du niveau is a phrase that ably portrays the lowering of an otherwise necessary tension. There are further criticisms to be made of the grotesque model. Namely, would not the therapeutic outcome of an official remedy be likely to express itself as a return to the socialisation of ward life? And surely any fall into melancholy inevitably lessens an individual performance and compounds the sense of personal depreciation. The accompanying feelings of failure and shame are no more than the first rank symptoms of this condition. I confess that it has not been my intention to deny the existence of depression as anything other than a wholly debilitating condition. Nor have I tried to resurrect a Langian or a mystical overlay onto this unwelcome experience. And I deny being engaged in the mere trading of metaphors in using grotesque realism as an approach to mental illness. Grotesque realism, the Material Bodily Sphere of the ancient carnival, is of service if only that it exaggerates the fundamental unfinalizability of the human condition. Highly mobile, the grotesque cartwheel constantly provokes our potential for surprise in that every aspect of its rotation reveals the possibilities of unexpected encounters. Grotesque’s spirit of pure improvisation is built upon an understanding that there is no final word in the minute-to-minute struggles of meaning. Even in the darkest inner voice of depressive dialogue there is the faint glimmer of some other, more positive, connection. As a polyphonic traveller I deliberately placed myself alongside a group of fallen practitioners. And I too became aware of the very different social characteristics of those who come onto this landscape to heal and those that come to be healed. Although forever dependent upon each other they are two very different worlds indeed. In the Care Chronotope the practise of viewing sufferers as individual cases has had the effect of reducing the power of the collective patient voice to the level of everyday chatter. Free to impose limits upon this trivial day-room dialogue the higher chronotope continues to pursue meaning its own unitary methods of interaction. Yet, alongside the patient practitioners, I have seen how other voices give meaning to suffering. One comes to realise that the unitary language is only one voice among many that offers wisdom and commentary on abnormal mental activities. By focusing on a collective re-reading of practitioner patients – who otherwise work in such close proximity to mental illness – I have revealed a most unfamiliar region of the psychiatric landscape. From

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this point onwards I will argue that the experience of patienthood is something more than the social consequences of an individual condition. As such, this is a region that becomes highly sensitive to further creative potentials and I put forward the somewhat mischievous proposition that if the experiences of the practitioner patients coincide with the condition of depression then what would happen if pretend patients began to trespass on this landscape?

Sacks, O., A Leg to Stand On, London, Picador, (1991) Rippere, V. and Williams, R., (eds), Wounded Healers: Mental Health Workers’ Experiences o f Depression, London, John Wiley & Sons, (1985). 3 ibid: p I05 4 ibid: p I5 5 ibid: p54 6 ibid: pp56-7 7 Jackson, C., ‘Coming out Crazy’, in Mental Health Nursing, Vol. 17, No. 1, (1997) pp28-9. 8 Faulkener, A. and Sayce, L., ‘Disclosure’, in Open Mind, No. 85, (1997) pp8-9. 9 Rippiere, V. and Williams, R., p90. 10 ibid: p I 03. 11 ibid: p81. 12 ibid: ppI 1 1-2. 13 ibid: p123. 14 ibid: p14 15 ibid: p24 16 ibid: p55. 17 ibid: p111. 18 Anon., ‘View from the bottom’, in Psychiatric Bulletin, Vol. 14, (1990) pp452-4. 19 Hughes, S., ‘Inside Madness’ i n British Medical Journal, Vol. 301, (1990), pp1476-8. 20 ibid: p 1477. 21 Anon: p452. 22 Rippiere, V. and Williams, R., p112. 23 Hughes, S., p1477. 24 Rippiere. V. and Williams, R., p79. 25 ibid: p153. 26 ibid: p1 8. 27 ibid: p 149. 28 ibid: p 18. 29 ibid: p14. 30 Hughes. S., p1477. 31 Rippiere, V. and Williams, R., p14. 32 ibid: p11 5. 33 ibid: p112. 34 ibid: p74. 35 ibid: p115. 36 ibid: p81. 37 ibid: p103. 38 ibid p 154. 39 ibid: p I 5 I . 1

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ibid: p 19. Hughes, S., ~1477. 42 Anon, p453. 43 Rippiere, V. and Williams, R., p18. 44 ibid; p112. 45 ibid: p18. A psychiatrist, transferred to a single room: 'longs for the mateyness of the open ward'. 46 ibid: p57. 47 ibid: p40. 48 ibid: p59. 49 Foudraine. J., Not Made of Wood, London, Quartet Books, (1974) p281. 50 Rippiere, V. and Williams, R., p44. 51 ibid: p53. 52 ibid: p 17. 53 ibid: p 139. 54 ibid: p19. 55 ibid: p64. 56 ibid: p93. 57 Jaspers, K., The Nature of Psychotherapy: A Critical Appraisal, Manchester, Manchester University Press, (1963) p22. 40 41

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Chapter Eight The Pseudopatients

If the interviewer suspects that the patient is feigning illness, he should ask simple factual questions such as “what colour is grass?” If the answer given is “blue” or some other response that indicates that the patient knows the correct answer and is deliberating distorting it, then he is almost certainly malingering. In this case the interview should be discontinued. Leff, J.P. and Issacs, A.D.1 No harm will be done to my journey if I take some time out to consider the old fairy tale of Apeleius’s Golden Ass. The interval will give me a breathing space to digest an entirely new chrontope; one that will add further flesh to the body of polyphony and at the same time suggest another method of travel. My reading is again through the borrowed eyes of Mikhail Bakhtin who built a specific chronotope from Apeleius’s collection of adventures.2 As a young man, Lucius, secretly watches a magician change herself into a bird and fly off into the sky. He imagines all the opportunities that this power of transformation would open for him and he decides to steal the magic potion. Unfortunately he steals the wrong ointment and as he applies it to his body he is transformed into the humiliating figure of an ass. From here he quickly descends into the low life of a world he was only recently familiar with. Let loose to wander the streets he enters upon a series of adventures each marked by a highly intensive timespace. He suffers a variety of indignities and assaults upon his body but before any encounter is allowed to become familiar he is sold on, or gets lost, or is kidnapped by 143

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robbers. Fortunately, and at the lowest point of his experience, Lucius is saved by a Goddess, and is returned, much the wiser, to the ordered world.3 It is the power of Lucius’s reconfiguration as an ass that gives this fable its narrative drive. His guise permits him to see otherwise ordinary events through the medium of a most improbable perspective. His tired eyes and his enormous ears are privy to all the secrets of everyday life for no one considers the presence of an ass to have any effect on what they do or say. One thinks of adult conversations taking place across the head of an infant at play or across a household pet snoozing in front of the fire. Or even of the intimate gossiping of nurses in earshot of sleeping patients. Lucius’s chronotope is highly suggestive of a different means of travel on the psychiatric landscape. To discover a timespace that sets ‘adventure time’ at the centre of the everyday opens up for the traveller a wide range of opportunities. The form of Lucius’s guise allowed him to wander freely among characters that were indifferent to his presence. And because his own demeanour was abjectly compliant he was able to descend into all the small refuges and unofficial spaces that weave themselves throughout the ordered world. His was a voice involved in an encounter yet a voice that had no meaningful standing within the ongoing dialogue. There are dangerous conclusions to be gathered from Lucius’s journey and herein lies the warning that polyphony is not just a matter of switching from one abstract perspective to another: changing a chronotope isn’t changing an intellectual approach; it means changing your life. In my introduction I proposed that to engage polyphonically with a façade as powerful as psychiatry it would be necessary to employ methods held together by the ethically dubious tensions of deception, mockery, or a variety of cunning practices. To travel freely on this landscape is dependent upon the traveller’s creative ability to alter the body of their own utterances. He or she must call upon sight lines that are indistinct or even absent from the official map. In the clinic these bearings are represented by the day rooms, the waiting areas, the stairways, the far end of dormitories, and in the overheard dialogues of passing voices. Invariably, many of these dialogues occur in the small hours of the night and in the quiet conversations that go round and round the walls of the day rooms. To begin I want to re-open a dialogue that was closed down towards the end of that period we know as the 60’s. I turn my attention towards a number of practitioners who sought to gain entry to psychiatric hospitals in the guise of patients. I am referring to the phenomena of Pseudopatients – otherwise sane people who deliberately feigned a mental illness in order to secretly observe the clinical processes of hospital life. Outside of forensic or military psychiatry the presentation of a simulated mental illness is so unusual that G. G. Hay4 has described it to be ‘memorable’ in any

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psychiatrist’s career. From a Manchester catchment area of 200,000, and over a ten-year period, Hay’s study found only one confirmation of a feigned abnormal state. Hay does not expand upon the circumstances of this individual but it is enough to say that the development of polyphony is not concerned with malingering or pathological impostors in which simulation has its more usual setting. This chapter confines itself to studying recognised professionals who chose to engage in this barely approved form of research. I intend to re-read, collectively, the research papers (1952-76) of a number of professionals – nurses, psychiatrists, anthropologists, sociologists, and psychologists – all of whom had a committed interest in mental illness. In the context of their day these studies were viewed as valid research projects that sought to win insight into patient life, explore an aspect of clinical practice, or to enhance a professional training profile. The pseudopatient’s stay of admission ranged from a few hours to several weeks. In some of the projects the researcher knows the hospital or the project is designed so that staff and patients are aware of the pseudopatient’s presence. More commonly, the project is covert and the presence of the researcher is not disclosed to others. It would be helpful to the traveller to understand why this form of research died out. Broadly speaking there are three reasons. Firstly, this branch of ethnographic research was very much a part of a particular epoch. It sat comfortably with the heady reactions to Erving Goffman, the polemics of One Flew Over The Cuckoo’s Nest, and the impact of anti-psychiatry. Pseudopatient research had its own status within the broader cultural events of the 60’s. Secondly, and in part as a reaction to the 60’s, psychiatry itself changed. The new liberalism that filtered onto the landscape substantially modified the traditional hierarchies of psychiatry by introducing customeroriented notions of informed consent and more relaxed methods of teamwork.5 The ethical profiles of veracity and advocacy became permanent third parties within the addressivity of professional utterances. Thirdly, the conduct of research also changed. D. L. Rosenhan’s paper On Being sane in Insane Places6 famously challenged the validity of diagnostic practices in a dozen American hospitals. Eight psuedopatients successfully gained admission to acute wards on the strength of a single first-rank symptom. Once admitted they were briefed to act normally but their sane behaviour went unnoticed by the staff. As a project, Rosenhan’s research sharply exposed widespread institutional processes in which people are categorised as sane or insane. Polyphonic travellers will do well to take note of the official response to Rosenhan’s paper. The reaction was immediate and savage and demonstrates the ferocious lengths psychiatry is prepared to go in order to protect its boundaries. The follow-on issue of Science7 carried fifteen letters, each one disturbingly hostile to Rosenhan’s project, and in the

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manner of a unitary language under attack from a lesser voice, sought to repel the intruder by first vilifying and then reducing the voice to the margins of validity. Rosenhan’s methodology, according to P. R. Fleischman, is ‘seriously flawed’ and displays a ‘total ignorance’ of the proper clinical method of diagnosis.8 O.F. Thaler accuses Rosenhan of using ‘pseudopatients [to gather] pseudodata for pseudoresearch study.’9 Two years later the Journal of Abnormal Psychology devoted a number of articles to give a more considered response to Rosenhan. But the passage of time did little to alleviate the anger of an affronted discipline. We learn that such research appeals only to ‘those entrenched in the romantic camp’10 it is dismissed as ‘stooge’ research,11 and no more than mere ‘publicity’.12 Two pivotal sociological papers (Dingwell and Bulmer13) sounded the final death knell for pseudopatient research in the early 1980’s. With the growing dominance of audit, risk assessment, and the new market forms of management, Robert Dingwell is concerned to protect the future standing of the ‘discipline’s credibility.’ Earlier ethnographic standards of morality, he argues, have now become ‘so absurdly difficult and self-destructive as not to be worth the candle.’ He goes on to say that sociology has ‘enough enemies’ without having to support the disregard of informed consent by covert researchers. Both papers put forward the premise that sociology must earn its trust within a society that, after all, supports ‘our occupation and the society which harbours it.’ Such hostility, of course, was reflected in the institutional turmoil that pseudopatient research caused at hos ital level. Staff members generally reacted with anger to both covert14 and overt15 studies. Redlich,16 a professor of psychiatry, recalls that when he gathered his staff group together to explain that one of their supposed patients was in fact a field anthropologist named William Caudill, ‘the majority were outraged’. Many felt that their trust had been betrayed and the standing of professional care itself had been degraded. At the same meeting one of Redlich’s closest associates openly accuses him of running ‘a sordid experiment.’ Just to one side of the subject of anger is another, more ominous caveat. Both Rosenhan and Caudill strongly caution future researchers about ‘the enormous personal consequences’17 that appears to accompany pseudopatient research. The subjects of hostility and the effect upon pseudopatients are important points and I shall return to them later. But for now it is sufficient to register the ending of this research. It was, in its own timespace, an expression of an earlier generation where an exaggerated subjectivity flourished briefly as the everyday norm. Rosenhan remains today as a minor figure in a cluster of personalities that made up the exuberant energy of the 60’s. Today his research is referred to only as an example in ethical debate or as a marker in which the world has moved on from. The point I would stress is not so

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much that this method of research exhausted its value, more, it simply stopped. A tourniquet, tightened by the arguments of a high ethical voice, had abruptly stemmed the life-blood of a powerful threshold dialogue. Since then its collective message has lain unheard and unsaid on the psychiatric landscape and my task, in the good company of Lucius, is to re-open this dialogue. In doing so I will learn that the psuedopatients found themselves helplessly caught up in the same processes as the practitioner patients. They, too, were suddenly drawn into unknown and wholly unexpected timespaces and, like the practitioner patients, the psuedopatients found themselves struggling with the same terrors of no-man’s-land. With varying degrees of impact both groups of practitioners make a primary position contact with grotesque imagery. Some of the psuedopatients make real contact with the Patient Chronotope and they report a world they are thoroughly unprepared for. Lucius’s experiences as an ass stumbling about in the low levels of life were to leave ‘a deep and irradicable mark’ on his subsequent demeanour in life. And so it is for the psuedopatients who entered into this chronotope.

FINDING ONESELF IN NO-MAN’S-LAND It is usual that a state of awkwardness accompanies the performance of an unfamiliar role. Feelings of curiosity and trepidation are mixed up with both real and anticipated fears. And in the collected voices of the psuedopatient literature these levels of anxiety are evident as they prepare themselves at the threshold points of their projects. Primarily, their fears are those anxieties that stem from the surrendering of a familiar professional role. Patienthood is fundamental to the identity of a proper practitioner standing and the panicky sensations the psuedopatients feel are indicators of the price a practitioner must pay for abandoning the mutual conditioning processes of the neo-classical body. Unaware of the full gravity of their acts the psuedopatients do not realise that there is a real line between what they have previously seen and what it can get to. William Deane18 was a sociologist employed on a psychiatric rehabilitation project. He plans to live on a psychiatric ward for seven days where he is already well known to the staff and the patients. Despite this knowledge he reports that the days leading up to his admission are marked by a ‘growing sense of apprehension’ where his moods swing between exhilaration and anxiety. In another project, two lecturers, Betty Mueller and Clinton Sherman,19 as part of a training programme, invite their student nurses to spend eight hours living as patients on a psychiatric ward. From some thirty student nurses they discover that ‘many are apprehensive about spending a day with patients’. One anxious nurse reports that she ‘lay awake

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the night before, anticipating situations’. Another, despite her familiarity with the hospital, said she felt fearful, ‘not knowing what to expect’. Echoing the patterns of the practitioner patients the psuedopatients find themselves undergoing the same sense of being expelled from the security of the Care Chronotope. And a feature of this expulsion is in the suddenness of its occurrence. In 1970 two American psychologists20 embarked on an experiment where one lived-in as a patient on an acute depressive ward and the other as a pretend patient on a long-stay psychiatric ward. ‘Quite unexpectedly’ and ‘immediately’ upon their admission both psuedopatients independently recall ‘a fear of betrayal.’ For no obvious reason they feel betrayed by their friends and their colleagues as if they are to be left on the wards indefinitely. To indicate the reality of their feelings it is noteworthy that one of the psychologists began to formulate an ‘escape plan’ despite his being free to leave the ward at any time. Deane finds an early visit from his wife marred by an uncharacteristic sense of ‘resentment’ towards her. He cannot accept that she is not hiding ‘some sort of bad news’ from him and he bitterly resents the fact that his wife and the consultant supervising his project both know the date he is to be released. His wife needs to reassure her disbelieving husband ‘several times’ that all is well at home and that his children remain as healthy as when he left them. In an Australian experiment a psuedopatient is abruptly transferred from the admission suite to a regular ward. Her anxiety is specific to one floundering in a no-man’sland: ‘I feel really destitute; no one has said anything about what’s going to happen to me. What kind of ward is this? What kind of people are here?’21 This sudden sense of loneliness and rejection has a profound impact on the psuedopatients. After only a few hours as a psuedopatient a nurse reports that ‘I have never felt so alone and deserted in my life’.22 No-man’s-land has a special sort of timespace. One, I am certain, that would be recognised by Lucius as he wandered around what was only recently previously familiar territory. The feeling of abandonment is matched by the helpless realisation that one is neither in one world or the next. Like Lucius the psuedopatient glimpses another world while still retaining a grip on a previous position. ‘I kept watching the other patients, not so much out of curiosity but uneasiness or almost fear. This is something I rarely experienced in a white uniform.’23 William Weitz,24 a clinical psychologist, is quickly made aware of the shape of the two chronotopical borders. On a ward he is about to commence working on he decides to spend twenty-four hours living-in as a patient. His identity is not a secret to the ward staff but he soon experiences the uncertainties of a no-man’s-land:

Gradually, I found my initial fears lessening, being replaced by a curiosity about the people with whom I was living. Interestingly enough, I did not find myself speaking toorinteracting with the ward staff to the

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degree I had anticipated, but rather I was more comfortable remaining alone, feeling out my role with the other patients. I had previously expected to spend most of my time talking and associating largel with staff personnel, [...] But, surprisingly, this was not to be the case.25 Weitz’s confusion is to grow during his stay. After twenty-four hours he admits he is more than grateful to return to the timespaces of the ordered world: ‘With the coming of morning I rapidly departed from the ward, anxious to regain control over my behaviour.’ A yearning for a return to a sense of certainty and authority is a common cry from this seemingly structureless terrain. As one dejected nurse relates: ‘One patient kept repeating over and over, “I want to go home.” I too felt the greatest desire for home’ .26 I have already introduced the most celebrated of psuedopatient studies in Rosenhan’s project whereby eight people – a psychiatrist, three psychologists, a paediatrician, a psychology graduate, a painter and a housewife – gained admission to various clinics under the guise of a single first-rank symptom. All were admitted and spent from seven to fifty-two days as in-patients on psychiatric wards. Rosenhan’s experiment was primarily concerned with the validity of diagnosis and only occasionally addresses the emotional impact upon his team of researchers. But it should be recognised that this world famous project almost floundered in the wilderness of no-man’s-land within hours of its commencement: The psychological stresses associated with hospitalization were considerable, and all but one of the psuedopatients desired to be discharged almost immediately after being admitted.27

ENCOUNTERING THE GROTESQUE Myths which day has forgotten continue to be told by night, andpowerful figures which consciousness has reduced to banality and ridiculous triviality are recognised again. Carl Jung28 The loneliness of no-man’s-land disguises an enormous anxiety concerning the real and the imagined. The security of a living chronotope has been discarded and the psuedopatient must now face alone the grotesque figures that wander in this region. Left to forage in this wilderness the psuedopatient encounters all manner of forces in which he or she can only articulate the turbulent and ambivalent reaction of the primary position.

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Deane’s voice is a voice pulled apart by two ideological forces. ‘Painfully and with difficulty’ he discovers That I had some actual fear of living with “crazy people”, that beneath the façade of my consciously enlightened attitude towards mental illness there existed an emotional acceptance of popular folklore about the “madman”. Also, although I was familiar with the hospital and knew it was a well-run and humane state institution, the stereotype of the “snake pit” lurked in the back of my mind.29 Don Rockwell,30 a trainee psychiatrist, lived-in as a psuedopatient for a period of three weeks. The same measure of ambivalent confusion were to occupy his thoughts: Even in this age of psychiatric revolution and enlightenment many of us continue to see patients as “them” and in a world different from “ours”. Prior to my “living in” I considered myself “objective”, “understanding”, “empathetic”, “unprejudiced” and so on, about the mentally ill. But the childhood ideas one has about the mentall ill persist [...] and serve as the nidus for the persistent “we-they ” split.31 In 1976 the anthropologist, David Reynolds,32 spent two weeks as an at risk depressive case on a ward for suicidal patients. At the beginning of his stay he confronted the imagery of the grotesque in an alarming fashion. After three days he grows increasingly resentful of the indifferent treatment he is receiving from some of the nurses responsible for observing him. Out on the recreation court he begins to construct a hangman’s noose and makes an all-too-real attempt to hang himself.33 I take note of the wild and contradictory feelings Reynolds uses to describe his attempt. ‘Joy! Fear!’ he begins his account: The only way I could punish them and avenge myself and disturb their holy routine and show them I meant business and escape any punishment they might wish to visit on me and mock and hate and spit on them all – the only way – was to hang myself.34 Reynolds is genuinely frightened by his attempt to harm himself. He is worried that the same ‘flood of feelings’ will threaten to overwhelm him again. Fortunately, He deliberately breaks the noose but not before selfinflicting several ‘red, angry marks, on his neck.’ More often, these dialogues with the grotesque are played out in the dark recesses of the night. In the uncertain space between reason and unreason long forgotten dialogues are persuasively replayed. All the certainties and all the masks of the official world are rapidly stripped away. Rockwell:

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That night as I lay in my bed all of the childish stereotypes about madmen and lunatics came back; all of my civilized, rational, educated veneer disappeared and I recognised how thin that veneer is in most of us.35 Deane’s first night found him awakening ‘innumerable times’. Still awake at six in the morning he writes of feeling extremely annoyed over the staff carlights flashing into the window and cutting across the ceiling. Later, his nights are to take on a much more forceful quality: ‘I went to bed with a definite sense of inner tension. I felt as though I were shaking inside and as though my muscles were going to start spasmodic jerking. I had a series of nightmares which seemed to be continuous.’36 For one nurse, the mere anticipation of spending a night on a ward is more than enough. She rejects the invitation with all the practical common sense that befits her profession. Offered the opportunity to extend the experience of living-in from eight to twenty-four hours, she responds: ‘You wouldn’t get me to spend a night in one of those dormitories for anything’.37

THE TIMESPACE OF THE PATIENT CHRONOTOPE ‘Time is different here – and life is different’. Don Rockwell38 As the hours and the days go by the psuedopatients adjust their bodies to meanings derived from strikingly different temporal and spatial settings. But the absorption of a new timespace is not always a gradual process. The experience can carry the same jolt of suddenness so characteristic of a grotesque impact. In the eight-hour projects of Mueller and Sherman many nurses are surprised at the ‘slowness’ of time. ‘I decided to ask to leave. I looked at the clock and much to my amazement, I had been there exactly 15 minutes’. The two psychologists soon note a sense of ‘agitated boredom’ and a ‘subjective change in time perspectives. ’39 William Caudill observes that the strongest impression of his first day was the ‘feeling of boredom and ennui existing among the patients, several of whom told him that tomorrow would be just another day with nothing to do but sit around, or play bridge and ping-pong,’40 On Deane’s second day he is met with a ‘sense of huge boredom’ where the ‘day dragged endlessly.’ Waiting to return after lunch to occupational therapy he recalls the frustration of having to wait until 1pm: ‘I had the same feeling of endless time, although the wait was not more than 45 minutes.’ Robin Winkler recounts that during a half hour wait: ‘Some of

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the men paced up and down: others just sat on the bed. The pacing seemed a little bizarre at first, but I found myself doing it without thinking.’41 Some psuedopatients suggest that this altered sense of time is due to their own disassociative mental states. But the Patient Chronotope has its own spatiality and own system of time and these perceptions are not to be judged from the standing of a previous chronotope. Deane is correct in observing that the timespace he is living in is more than a perceptual distortion. There are parts of the hospital he has seen many times before but now they appear to him as ‘different.’ He is convinced that what he sees is the ‘familiar made unfamiliar’ and through a ‘different set of eyes.’ Set to work in the hospital laundry he is made aware of a relationship to spatial realities not previously available to him. He finds himself ‘looking intently at all the machines and gadgets, but actually having no interest in any of it.’ There is a similarity here with Stephen Hughes, the practitioner patient who was admitted with a post-traumatic-stress reaction. Hughes’s changed reality also included intense fixations on everyday objects, namely, electrical sockets and a ward trolley. Caudill observes that some objects assume an importance out of all proportion to what they occupy elsewhere. A new couch delivered to the men’s ward becomes the ‘focus of attention for over a month.’ The two psychologists make much the same point in noting that relatively minor spatial changes take on an otherwise disproportionate significance. They cite the example of an unexpected dessert at lunchtime becoming ‘the event of the day.’ These observations display how the transformation of spatiality becomes merged into the temporal landmarks of the day and as markers they carry their own meaning and faithfully represent the passage of time: Little things become very important around here. You don’t use the days ofthe week to tell the time, but you say, ‘Oh, that was the day we waited in the hall for thefloor to dry after breakfast instead of going into the day room ’. Or ‘That was the day we had ice cream ’. You start to think just about what happens in here, and any change in the routine becomes tremendouslyimportant.42 The contrast in the way the two chronotopes organise their timespace is forcibly illustrated when Don Rockwell, on the eleventh day of his stay and weary from a second ‘dreary’ weekend, takes time-out from his psuedopatient role to sit-in on the staff meeting: People actually looked different today – physically more distant – and I was suddenly acutely aware that the difference was in the staffapproach to Monday morning – the attitude of “A new week, well, lets get to work! ” which I could no longer even begin to share. For the patients and for me today, this morning isjust the beginning of another long day, an extension of yesterday which will merge into tomorrow. 9am this

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morning has become no different from 9am yesterday, and only slightly different from Yam tomorrow.43 Days, hours, weekends, time off and time on, are all meanings that carry different values and different durations. The great forward-rolling time that drives the Care Chronotope is powerful enough to radiate its own values outwards and onto the fibre of lesser chronotopes. By making another timespace insignificant it ensures the validity of its own temporal standing. Reynolds again: “How was your weekend? ” I learned that this opening gambit was pretty standard throughout the ward. It had different meanings, though, depending on whether it was asked by a patient or a staffperson. For staffthe day was divided into hours on the ward and free hours, the week into workweek and a weekend. The weekend was for recreation, for getting away, for trying on new roles, seeing new sights. For the patient the weekend was an attenuated extension of the week – more time in which to do less.44

CLINGING TO THE WRECKAGE: SPACE AND INVISIBILITY There are real spatial dangers in allocating the mad to a fixed segment of the grotesque cartwheel. Certainly the idea is administratively tidy but the boundaries remain as artificial as any of those fabricated by early imperialists who drew arbitrary lines across ancient tribal lands. By choosing to govern this region through various systems of standardised procedures the Care Chronotope pays a powerful perceptual price. Whatever way this region is arranged there are acts and events that will continue to organise themselves and move in quite unplanned directions. Things happen and things move in this region that the Care Chronotope cannot see. By remaining with grotesque’s guiding model these movements can be seen in the turbulence that the psuedopatients are experiencing. They are wandering in a transitional zone between creativity and destruction, and demise and renewal. It is little wonder that the feelings they experience reflect the same ambiguity of no-man’s-land: anger and frustration, listlessness and boredom, betrayal and paranoia. This negative ragbag of reactions accurately describes the position of an individual striving to comprehend a seemingly precarious and unfamiliar position. I could safely speculate that a group of professionals posing as patients on the same ward would undergo an entirely different experience. But the lone psuedopatient, having effectively squandered the investments entrusted to him by the neo-

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classical body, becomes rapidly lost in these uncharted regions. For the moment there is little to cling onto. However, the twentieth century insists that the root of abnormal mental states must be sought from inside the individual, and in their own appraisals some psuedopatients choose to explain the events that unfold around them as arising from within themselves. Listen to Don Rockwell as he attributes the following events to his own ‘pre-existing character traits’: One Sunday morning I was sitting in the dayroom reading the newspaper. Through my peripheral vision I noted that the nurses and the doctor on duty were in the nurses ’ station and were “watching me ”. I became self-conscious and anxious. They suddenly began to laugh – inaudibly, but visibly, through the glass of the nursing station. LAUGHING AT ME! was my immediate reaction, and my anxiety was compounded with anger and a creeping concern over what they might be laughing about. I had no idea, but the suspense overwhelmed me and I got up and went to the nursing station. I was paranoid for a brief but vivid moment.45 Rockwell is in no-man’s-land and he is using the wrong map. The panoptic nursing station – visible but not audible – is an important symbolic space denoting the concentration of authority. Those that congregate in this space are mutually massaging their identity by fragmenting the transgressive body of Rockwell. The space a body occupies and the conduct in which it performs is the hallmark of the neo-classical body. Even within the body there is a social division as to the proper ways things go into the body and to how things should come out it. Significantly, all staff groups have their own toilets and their own private ways of dealing with elimination. Often, the staff group has its own – ritually sanitised – cups, cutlery, and plates. Some night-duty staff insist on spreading fresh sheets on patient’s armchairs before they themselves will sit down. I am reminded again of an earlier observation that it is the celebratory aspects of the carnival – the communal eating, bodily contact, the lower bodily strata, - that are most singled out for segregation in the official world. It is interesting to note that Mueller and Sherman record that all of their [female] nurses objected to using the patients’ toilets. Several preferred ‘waiting all day’ rather than use a toilet allocated for patient use. Because the concentration of authority is displayed by the positioning of the body practitioners are often guilty of making the standing of lesser bodies inconspicuous. This practice can be demonstrated by the act of simply not seeing the other body: I ask a female nurse on obs: “Could you tell me when I get my clothes back?” Nurse: “No, I couldn’t. ” She doesn’t stop, doesn’t pay any more

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attention even though she turns around and walks past me again. Walking back down the corridor I am bumped by a female staff member (Dr?). Just keeps on walking, doesn 't apologize – I feel angry at her denial of me.46 These narratives lend support to the idea that the Care Chronotope has overwhelmed the definition and the reality of this landscape. The result of making various settlements into passive sites of care has meant that real living movements have been made trivial or even invisible. I make the point that the defining quality of a culture locked into a secondary position is one that is highly selective in its sensory range. Things are seen and not seen. Voices are heard and not heard. One psuedopatient nurse comments that what bothered her the most was that 'some staff members who came on the ward [. . .] would look through the patients as they passed, as if they didn't even see them.’47 Reynolds complains that his own world begins to shrink in the process of his admission to the clinic: ‘My world was just slightly larger than the space my body occupied,’ he writes. Sat in the waiting area on the day of his admission his body image begins to shrink with an alarming rapidity: As I sat and caused no trouble, people ignored me except when I was in their way. The workers who were sweeping and mopping asked me to move out oftheir way. Otherwise, there was no attempt at conversation, no move tofind out why I was sitting there, and no attempt to see me as a human being. People looked through me.48 But it is Rosenhan that offers the most striking example of the patient body being made inconspicuous: A nurse unbuttoned her uniform to adjust her brassiere in the presence of an entire ward ofviewing men. One did not have the sense that she was being seductive. Rather, she didn 't notice us.49 In this incident we have a powerful example of a perspective carrying a 'disinterested surplus’.50 The nurse is indifferent to the response of the other. She considers the sexuality of the men gathered before her as inconsequential. It is unthinkable that she could repeat this act in the staff canteen. Yet it is not the act of this nurse publicly adjusting her underclothing that is so important. We must look to the traditions of the social organisation that lies behind it. The embrace of the neo-classical body grants to this nurse a standing of extreme confidence. Such standing is earned only by the display of one's position before the unassertiveness of another. Her act is transformative of the ancient relationship that defined a master and a servant. Abram de Swan writes of a time when the social

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distance between masters and servants was so vast that the feelings of the latter needed no consideration. In a word, a servant was a non person. That explains why the master or the inistress of the house felt no embarrassment in appearing nude in front of servants and allowed them to wash, dry, and dress them without misgivings.51

THROUGH THE GATES OF THE PATIENT CHRONOTOPE: DISCOVERED FELLOWSHIP The practice of gathering the mad together into fixed settlements carries consequences for both chronotopes. For the carers who construct narrow perceptual surpluses on the body of people who reside there, and for the patients, who for the most part, must respond passively to their environment, waiting patiently for their individual treatment plans to take effect. It will come as no surprise to discover that the psuedopatients are drawn, like their practitioner colleagues before them, towards a voice that offers a source of comfort and hope. In fact it is the recognition of this previously unheard collective voice that marks the lone wanderer's deliverance from no-man'sland. But the entry into the Patient Chronotope is not always obvious. Points of contact are rarely premised on the more generally understood forms of social interaction. Quite ordinary utterances and quite simple social acts often shape the encounters that occur. It is the very level of ordinariness that make these social interactions invisible and unheard to the higher chronotopes. But at a different level of meaning these acts can appear to be extraordinary. Individuals, lost and abandoned in some terrifying mid zone, are rescued and pulled into the complex collective voice that is driven by the Patient Chronotope. And, like all chronotopes, the Patient Chronotope is alive and living with its own spaces and its own temporal directions. Rockwell is more than surprised to stumble into this world: An interesting network of communication exists among the patients and between the patients and nurses – networks that are largely unknown to the resident [the trainee psychiatrist]. The ward I had known as a firstyear resident wasfar different from the same ward as I came to know it while living on it. The patients ' ward is strikingly differentfrom the ward the psychiatric resident thinks the patient lives on, and surprisingly differentfrom the ward the nurse works on for eight hours a day.52 For Deane, the discovery of the Patient Chronotope is spatially expressed. On his second day and feeling increasingly resentful towards the

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staff, he begins to develop ‘a closer identification with the patients.’ Gradually, the ‘feeling of identity with the patients and the social distance from the staff began to increase.’ On the fourth day a patient who had shown an interest in him invited him to meet a group of his friends on another ward. ‘I began to feel benevolent and gay. I talked with all the men, who were extremely friendly and complimentary toward my stay. A patient named John Holton said he felt all that all the doctors should do this. I agreed heartily, taking a sardonic delight in the idea.’ In this simple conversation Deane records that his ‘whole emotional state underwent a sudden change.’ In fact Deane is being pulled into the power of a new chronotope. Within the orbit of this new living voice he is able to find a sense of certainty from a different set of values. Suddenly a new form of consciousness, one that long pre-exists the context this encounter, is made available to him. Later, returning to his own ward he makes contact with a patient named Hunter, a very ‘high’ manic. Up to now Deane had found Hunter’s chatter to be ‘wearying:’ ‘but now I talked with him eagerly and felt a great fellow feeling with him. His incredible ramblings seemed to make more sense than before.’ Deane is to take more comfort from his new friends. The next day he returns to their company complaining of feeling ‘depressed and hopeless.’ He tells them he feels ‘lousy’ but he his much reassured by the wisdom of their everyday response: ‘a combined reaction of amusement and sympathy.’ Eventually, on the day of his discharge, Deane goes to this ward and makes a heartfelt farewell: ‘I shook hands with all the men and had difficulty holding back tears.’53 David Reynolds, sitting dejectedly in a dayroom chair, remembers an unknown patient occasionally walking by him or standing silently by his chair. Throughout the day this patient gently touches Reynold’s arm: ‘These hesitant forms of contact were helpful to pulling me out of my depression.’ As his stay continues Reynolds is made aware of the way voices are arranged on the ward. Like every social world the Patient Chronotope carries its own system of stratification and standings. Towards the end of his stay, as he recovers and begins conversing with some of the staff, he notes that the ‘older, sicker patients began to avoid me, and to fail to respond to my efforts at conversation. It was if they were communicating to me, “We don’t need each other anymore’’’54 In the middle of his stay Reynolds describes an encounter with a newly admitted patient who is determined to cling onto the wreckage of the ordered world. The act of rescuing this patient is rich in Reynold’s new-found wisdom: At dinner I sat near Mr H who occasionally did strange things, such as putting a teaspoonful of’ hot coffee in his shirt pocket. He also kept cigarette butts in his ears. One new patient at the table, on seeing the coffee gambit, seemed personally offended and told Mr H he was acting

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“crazy”. I responded, “It’s a small price to pay”. The old-timers around the table nodded, though the young man seemed to think my speech was crazy, too. What I meant was that crazy behaviour hurt no one yet it ensured Mr H’s right to stay in the hospital where he was comfortable. Mr A, another patient seated next to me at dinner, had told me earlier that he could shift his mental view of things when he became bored in the ward so that everything looked new again. I told him I envied him: I couldn’t do that. He replied, “You can’t be expected to do it. It took me sixteen years to learn how. You can’t learn overnight.” I turned to the young patient: “We have a lot to learn from theses two, Mr H and Mr A”. Thefour of us agreed that it was true. Our elders had learned to adapt in a nondestructive way to the hospital environment. They were relatively satisfied with their experience as it was. They had come to terms with patienthood 55. Reynold’s vignette is one of many encounters that are unseen and unheard by the Care Chronotope. Yet the wisdom and comfort in this dialogue is directed wholly towards a regenerative definition of giving meaning to someone’s standing on this landscape. This is the action of a cartwheel in progress. This is evidence that no voice can ever be trivialised or made mute. A voice simply finds another way to breathe. Bakhtin’s dialogue with Orthodoxy applies: There is neither a first nor a last word and there are no limits to the dialogic context [...] At any moment in the development of the dialogue there are immense, boundless masses of forgotten contextual meanings, but at certain moments of the dialogue’s subsequent development along the way they are recalled and invigorated in renewed form. Nothing is absolutely dead: every meaning will have its homecoming festival.56 Reynold’s acceptance by his fellow patients was greatly aided by the way he chose to reconstruct and maintain his bodily utterances. He did this by exaggerating his own characteristics. With practice, he suggests, most people can put themselves into a state of depression. After all, everyone knows what it feels like to be down or to come out of a mood of dejection. But to perform this act of simulation not only puts pretence and reality under tension in the clinic it also resonates into the world of the Patient Chronotope. Rosenhan’s project drew telling conclusions from psuedopatients required to act insanely at their admission interview, and, once admitted, to act sanely in what was an insane place. He argued that is was significant that none of his eight psuedopatients were detected as being sane by the ward staff. In fact, on their eventual discharge, each psuedopatient was given the diagnosis of ‘schizophrenia in remission.’ Yet

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in contrast to the staff Rosenhan notes that it was ‘quite common’ for patients to detect sanity in the psuedopatients. Indeed, Rosenhan’s observation is more than an isolated comment from the occasional patient. His team reported that some 35 patients out of a total of 118 expressed their suspicions to the psuedopatients: ‘You’re not crazy.’ They said. ‘You’re a journalist, or a professor. You’re checking up on the hospital.’ Overall, I believe Rosenhan’s comments are more important in what they say about the inaccessibility of patient dialogue rather than in the questions they pose about diagnosis. I would argue that the staff of Rosenhan’s hospitals were already trapped within the restricted nature of their surplus perceptions. As Judi Chamberlain suggests in her commentary on the Rosenhan experiment: ‘Staff are so conditioned to viewing anyone who comes before them in the role of the patient as sick that they have a hard time picking out imposters.’57 The masks of insanity that Rosenhan’s team wore did not take account of the communality of the patient group they found themselves within. The energy of their masks was primed only for the admission interview. Rosenhan demands high standards of heroism not only from his researchers but from the ward staff as well. To suggest they should have detected sanity in a psuedopatient is to ignore the powerful sub-text that runs through the Care Chronotope. For the ward staff to expose the psuedopatients as sane and guilty of feigning insanity would be, by default, directly challenge the standing of those practitioners who performed the admission procedure. The observation outrages the power of the physician’s gaze itself. The viscosity of the neo-classical body would be punctured and the standing of proper practice be seriously damaged. Such acts of boldness are performed by fools or by heroes. What is to be gained from Rosenhan’s narrative is that in the various refuges of ward life – the unofficial spaces of the psychiatric landscape – a wide range of dialogues are taking place. The wisdom contained by the Patient Chronotope recognises the carnivalesque ‘temporary suspension of the official truth.’58 It is the privilege of the insane, traditionally permitted to voice the unsayable,59 to call out to these trespassers: ‘You’re not crazy!’ The power of Rosenhan’s masks faced outwards across the border of one meaning and onto another. The masks were never intended to carry meaning alongside another. At the admission interview the psuedopatients knew exactly who they were. Their immediate task was to act with the mask. The fear of being unmasked by the screening physician was the fear that prevented the psuedopatients from abandoning themselves to they act they performed. According to Rosenhan the psuedopatient’s greatest ‘shared fear was that they would be immediately exposed as frauds and greatly embarrassed.’ But once the performance was successfully completed they were at liberty to discard their masks and live as sane individuals in the

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timespace of the insane. Through their masked acts the ordered landscape of psychiatry had been temporarily inverted but the patients on the ward did not unmask the psuedopatients because they wore no masks. Such an act of deception was greeted in the Patient Chronotope with incredulity and amusement,60 a quite different sense of value from those that structure the Care Chronotope.

THE CASE OF WILLIAM CAUDILL AND THE CIRCLES OF PARODY It can be said then, that in ancient times the parodic-travestying word was (generally speaking) homeless. All these diverse parodic-travestying forms constituted, as it were, a special extra-generic or inter-generic world. But this world was unified, first of all, by a common purpose: to provide the corrective of laughter and criticism to all straightforward genres, languages, styles, voices; to force men to experience beneath these categories a different and contradictory reality that is otherwise not captured in them.

M.M. Bakhtin61 Of all psuedopatient research the case of William Caudill62 merits the most attention. Not only can Caudill's sojourn be considered the first psuedopatient experiment but the length of time living as a patient – approximately two months – counts as the longest. What is significant about Caudill's study is that his extended stay reveals much wider insights into a voice that is only fleetingly perceived in the shorter projects. Fritz Redlich, then a professor at the Yale Psychiatric Institute, had pondered at length as to why so many patients failed to respond to officially sanctioned intervention. His clinic, specialising in the in-patient treatment of psychoneurosis, ran a psychodynamic regime in which each patient met daily with an assigned psychiatrist. In these so-called conferences patients underwent a prolonged psychotherapeutic course of treatment. Redlich wanted to know what was it that actually helped his patients? How did they get well? And what effect did patients have upon each other?63 In the light of these questions Redlich invited William Caudill, ‘a young and gifted anthropologist,’ to enter his clinic and live as a concealed patient. By exaggerating some of his own personal foibles – overwork, alcohol, irritability – Caudill successfully reconstructed his utterances to present a suitable case for treatment. At his screening interview he was diagnosed with a ‘character neurosis’ by his psychiatrist who was to remain convinced

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that Caudill was sick throughout his stay. Once admitted, Redlich fully expected Caudill, a trained social scientist, to uncover ‘maximally objective and detailed infomiation.’ This was not to be. Something went scientifically wrong: To our surprise we found that Caudill did not remain objective. He became a member of the patient society and identified with the patients. Temporarily, Caudill really became a “patient”.64 Caudill was to deeply regret his experiences as a psuedopatient. In the prefa ce to his book, The Psyciatric Hosital as a Small Society, he sta tes that he felt the ‘price to be too high’.65 He was ‘decidedly uncomfortable’, both morally and emotionally, about his period of concealment as a patient. I have already described the outrage of the staff and the accusation of sordidness when Redlich announced the ending of the project to the clinic’s staff. Such was the negative effect that Redlich came to believe that Caudill ‘as well as many of my psychiatric colleagues after this experience should have received medals for injuries to their narcissism in the service of science.’ We have to wait until Caudill’s death he died suddenly from cancer in 1972 to discover the profound effect the experiment had for him personally. In a memorial editorial66 two former colleagues recall Caudill’s ‘inner turmoil’ concerning his experience: ‘The strain on Bill between his role as an objective observer and his human sensitivity to people who were deceived by his dissembling developed into a very severe personal and career crisis.’ At the same time Redlich disclosed his knowledge of the ‘considerable antagonism’ that had occurred between Caudill and some of the nurses that had involved ‘repeated quarrels and even fights.’67 Rosenhan was certainly aware of the personal effect on Caudill prior to his own project: ‘He [Caudill] was consumed with guilt over deceiving his colleagues and his report of his experiences was an excruciating warning to subsequent scientific generations that such elaborate deceptions can have enormous personal consequences. ‘68 This knowledge alone was sufficient for Rosenhan to instruct his team of researchers to abandon their symptoms in order to reduce the potential for personal distress. Caudill’s narrative is a paper whose style strives to achieve the austere criteria set by early post-war American scientific vocabulary. Much of the subjective nature of Caudill’s paper has been deliberately expunged and we are left with a record of a highly subjective experience filtered back through the language of a closed scientific objectivity. At first sight the separation of the real from the approved would seem a loss to the purposes of my project. For even in the shortest psuedopatient experiments the emotional reaction of researchers was a fertile source of analysis. Yet, after several readings of Caudill’s paper, I became aware of a quite novel perspective lying dormant

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in the words before me. So skilfully edited has the paper been in neutralising the effects upon the researcher that the recorded dialogue of the patient voice had become sharply accentuated. Unwittingly, his paper allows the reader access into a highly privileged insight into patient dialogue. Indeed, his paper can be more usefully seen as a collection of narratives wholly uninhibited by the presence of a higher form of discourse. In striving to maintain the sanctity of a unitary code, Caudill’s paper, in the terms of David Lodge, ‘generates patterns of significance which were not consciously intended by the author who activated them, and which do not require his “authorization” to be accepted as a valid interpretation of the text.’69 This is not to say I have licence to do wildly distort Caudill’s observations, but the declared gaps in the text and the striking differences in the tones of patient dialogue and the official word, suggests that the paper carries more than a singled-sided utterance. Accordingly, if I remove the voice of the higher authority from the paper I am left with those voices that represent points of progression on the cartwheeling process of the Patient Chronotope. Furthermore, if I also disregard the trivial and mundane topics under discussion [as unworthy of consideration?] it becomes difficult not to see collective patient interaction as part parody upon the prevailing order.

THE CIRCLES OF PARODY Odysseus, as is well known, donned a clown’s fool’s cap (‘pileus) and harnessed his horse and ox to a plow, pretending to be mad in order to avoid participation in the war. It was the motif of madness that switched the figure of Odysseus from the high and straightforward plane to the comic plane of parody and travesty. M.M. Bakhtin70 Bakhtin makes few references to madness. Where he does he uses the concept more as a literary device, more as a means of freeing the consciousness from inner and outer dialogues. He offers no individualised evaluation of madness. Its voice is always set within the social; its utterances are always expressed in the spirit of something being part of something. What is important is Bakhtin’s angle of approach towards his subject. Madness, for him, is always seen through the ancient eyes of the folk narrative of the grotesque form, making:

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men look ut the world with different eyes, not dimmed by “normal”, that is by commonplace ideas andjudgements. In folk grotesque, madness is a guy parody of official reason, of the narrow seriousness of official truth.71 Modernity’s positioning of madness – ‘the most solitary of afflictions’72 – is a responsibility Bakhtin again lays squarely at the door of the enlightened Romantics. It was here that madness surrendered its social linkage and acquired its ‘somber, tragic aspect of individual isolation. ’73 On all of my journeys up to now I have noted the paradoxical practice of gathering the mad together in fixed settlements yet insisting their recovery should be achieved by individually-driven interventions alone. Whether I tread the boards of Bedlam or sit-in on a series of introductory lectures I cannot help but note the narrowness of official reasoning. This makes it difficult to track down the mischievous and dual-natured aspect of the grotesque realism in the official texts. One important commentator who falls within the range of the official word is Louis Sass. By inverting the more common forms of clinical gazing, Sass manages to go beneath this level of meaning and bring into focus a sense of the social and the carnival as it is expressed through the utterances of madness. Suspicious of all diagnostic interpretations, Sass regrets that clinical descriptions of the ‘inappropriateness of affect’ so often fail to stress that an incongruous social response is often of a specific kind. He lists ‘laughter,’ ‘giggling,’ ‘grinning,’ and an ‘ironic or perhaps self-absorbed and self-satisfied smiling’ as prominent parts of the schizophrenic voice. But Sass takes his observation further. Using what I would term the everyday knowledge base of the Care Chronotope he portrays a readily identifiable account of a typical clinical encounter: No one who has interviewed schizophrenics will have jailed, at times, to have the sneaking suspicion that the whole interaction is, to the patient, something ofajoke. Often this tone is quite subtle, and the interviewer is left wondering whether the patient is really involved in the conversation, or is essentially detached, watching and mocking the whole event as if from somewhere far above.74 Caudill’s stay was spent upon a psychoneurotic ward and his world was not seen with so psychotic a set of eyes. But it is only through Caudill’s enfleshment in this world that we are allowed a privileged glimpse of another, more powerful, direction that lives in this chronotope. In the first of his dialogues it will be seen that the voices of the Patient Chronotope are anything but fixed. This is a voice in continuous movement. One that goes around and around in endless circles of apparent triviality. Indeed, in all

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these conversations the focus is never far from simplicity and the value of the everyday: The patients knew that the nurses, particularly the students, sat around in the living rooms “in order to get material for their reports ”, and hence the patients felt that the nurses were fair game for occasional kidding. For example: A nurse was listening to a conversation between Mrs Lewis and Mr Brown. So Mrs Lewis joked with Mr Brown by saying, “You didn’t come in and say goodnight to me last night”. Then she turned to the nurse and said, “You know, Mr Brown is in and out of my room all night long”. Mr Brown smiled and said, “Yes, of course, that’s true.”75 For Bakhtin, the single-toned flavour of administrative discourse has done much to weaken parody’s ancient powers to simultaneously degrade and renew the object of its intentions. So sickly and insignificant has this once proud genre become that its definition has almost been absorbed into the destructive forces of satire. But satire’s responsibility ends at the moment it abandons its subject at the material bodily level. It has no brief to return it’s subject to a living position. Bakhtin refuses to accept parody’s demise. As a force of the ancient carnival he stresses parody’s undying ambivalence and its multi-voicedness. Every parodic utterance, he argues, has a twofold addressivity: ‘it is directed both toward the referential object of speech, as in ordinary discourse, and towards another’s discourse, toward someone else’s ,speech. ’76 By the use of caricature or comic exaggeration the voice of another is recast in a way that is counter to their original intention. Gary Saul Morson77 observes that official dialogue has always defended its position by shrouding its voice in ‘alien scripts or dead languages.’ It is for parody to inject a new and different ‘semantic direction’ into this restrained voice. In doing so each parodic utterance becomes a site of confrontation in which two estranged voices are in conflict. Yet the audience, fully aware of the intent of both voices, knows which voice represents the higher authority and, in context, ‘knows with whom it is expected to agree.’ Bakhtin illustrates the once renowned multi-voicedness of parody by arguing that antiquity sanctioned, and even expected, the parodic addition of ridicule onto its official discourse: There never was a single strictly straightforward genre, no single type of direct discourse – artistic, rhetorical, philosophical, religious, ordinary everyday – that did not have its own parodying and travestying double, its own comic-ironic contre-partie.78 Through the medium of the ‘fourth drama’ - the fourth act that traditionally followed the end of every tragic trilogy – Bakhtin saw the

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addition of the parodic voice onto every official commentary. It was the function of the fourth drama, with its ruthless cleansing power of laughter, to rework the previous themes of the play in an entirely different interpretation. By its sheer vitality the parodic drama weakened and degraded the singledsided seriousness of a previous rational perspective but, at the same time, rebuilt its meaning in a re-integrated and more comprehensive fashion. Bakhtin expands the characteristics of these dramatic discourses through an explanation of the ‘serio-comic’ genre in a way that runs parallel to Lucius’s travels. In the same way he is also offering the polyphonic traveller a fertile and meaningful point of reference. Firstly, the serio-comic genres that so enliven the fourth drama are to be recognised by their ‘ordinary freedom of plot andphilosophical invention’ .79 Ideas and themes, pillaged from more approved genres, become ‘provoked and tested’ by deliberately placing them in ‘extraordinary life situations’. Everyday events are re-created and their meanings are further tested in the ‘slum naturalism’ of low life settings. Taverns, marketplaces, dens of thieves, and brothels are given as examples. Bakhtin never permits us to forget the organic connection to the Material Bodily Sphere. Freely wandering among the adventures on the high road the serio-comic genres work by continually provoking dialogue between the more ordered world and the baseness of slum naturalism. And, finally, it’s brazen ‘scandal scenes’ prompt ‘ all sorts of violations of the generally accepted and customary course of events and the established norms of behaviour and etiquette.’ It will be seen that many of Caudill’s examples of patient dialogue are representative of a parodic commentary on the days events. As additional dialogues they take place in the unofficial spaces of the clinic, where in the context of fellowship, the truth of their meaning can be further ‘provoked and tested’ against the power of the official voice. In the following ‘scene of scandal,’ enacted we are told on most evenings, a voice is addressing two different semantic directions, two different approaches to the truth of things. As a ‘fourth drama’ upon the official organisation of the day there is in Mr Davis’s impertinence a temporary triumph over professional pomposity: Dr Johnson came by on evening rounds and Mr Davis made a great fuss, taking him down the hall and swearing violently at him. After Dr Johnson had left, Mr Davis stormed back to the table saying that Dr Johnson told him that by such actions he was trying to destroy all the patients on the ward. But, Mr Davis continued, all that he wanted out of life was to be a punts presser; he did not want any of the intellectual stuff. Mr Brown and Mr Hill told Mr Davis that he only created these scenes when his doctor showed up; he did not need to do this as he was all right and quiet at all other times. Mr Davis admitted this.’80

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Caudill refers to an on-going debate among the patients in which they express their ‘frustrations and doubts’ about the clinic’s efficacy: ‘because few patients seemed to get better, or to leave the hospital as “cured.”’ There is a general dissatisfaction with their doctors’ whose main concern seemed to be to get them to surrender their ‘defences.’ Mr Hill took exception to this strategy. He saw no reason why he should give up his ‘defences’, after all, if he did, ‘what would he have left?’ Equally, in the spaces where these additional dialogues take place, the patients come to develop skilful levels of caricature: ‘The characterizations made by the patients of the doctors’ personalities seemed to be a blend of projection by the patient of his problems onto the doctor, and a very astute, intuitive grasp of the doctor’s own emotional and social problems.’ Caudill, in the fashion of the day, continues to see this voice in individual terms. But the parodic motif that runs through these dialogues is something more than this. Parodic commentary is made possible only from the practised fellowship of a community. It is a communal voice that belongs to different order of time and space. In what are essentially fourth dramas upon the events of the day we are made privy to Bakhtin’s ‘different and contradictory reality that is otherwise not captured.’81 In the Patient Chronotope there are multi-levels of semantic direction taking place. Many are in direct conflict with each other yet when they are taken together, they introduce a renewed orientation to an event. Such unofficial dialogues are a powerful means of rediscovering everyday experiences: Mr Hill and Mr Davis got into a discussion about the differences in their conferences. Mr Hill said that Dr Black worries more than he does. He said that they both sit and frown at each other and look worried. Mr Hill said that he would say something and then sit and worry about it, and Dr Black would look at him with a worried expression and say, “What do you think that means?” They would then sit in silence and worry together for a while. Usually about that time the sounds of an explosion would occur in the next office and it would be Mr Davis screaming and swearing at the top of his lungs at Dr Johnson. Mr Hill said that one day Dr Black had inadvertedly laughed at something Mr Davis was shouting at Dr Johnson in the next office and then Dr Black was confused and embarrassed toward Mr Hill over the effect his laughter might have had on the conference hour.82 Despite such examples it can be seen how easily inter-patient dialogue can be taken for harmless conversations seemingly over concerned with the minutia of life. I am assisted here by Linda Hutcheon’s83 commentary on Bakhtinian parody to place this observation in perspective. For her, parody is a form of mimicry coupled to a critical distance. She determines the

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varying powers of parody from its position on a social continuum, with an intent ranging from a ‘respectful admiration’ to a ‘biting ridicule.’ She stresses that parody must be kept separate from modem satire for its purpose is not to annihilate its target. Once we unhitch parody from its association with modem satire then we are left with utterances whose intention is something more than the negation of its subject. In Hutcheon’s critical distance, and indeed in the Patient Chronotope itself, there is no direct political or moral challenge to the authority involved. For, at base, the distance that governs parody’s twofold direction is a distance that permits the expression of reverence and mockery. Hutcheon’s observations go a long way to account for the cautious simplicity and routine aspects of patient discourse. These dialogues belong to a different time and space. They are a part of the endless conversations that are shared in all the quiet recesses of the clinic. Hushed and private dialogues that take place over ill-prepared cigarettes and mugs of low quality tea. Parody is another verbal windmill circling on this landscape and the patient voice, so concerned with talking about subjects rather than with taking action, freely load their utterances with its potentials. A further insight is offered by Hutcheon’s notion of critical distance. This position allows a voice to temporarily enter a wider social cycle whereby escapes from everyday timespace become possible. Rehearsing different relationships to truths made passive by parody gives a voice a short-lived break from the security of routine. Critical distance permits a voice to stand, as it were, on the threshold of parody’s orbit, and to test out a new truth with all the force of parody’s ‘extraordinary freedom of plot and philosophical invention.’84 David Reynolds: Mr S. was entertaining [us] with his ramblings. He called me “Tiny Tim of Infinity”. He told us that planets ran automatically by remote control, and when astronauts land on them, they will found they are worn out. He said that evil-frozen-hard will fail because he has conquered it.85 In the space that allows this critical distance to prosper different truths are provoked and tested. And, sometimes, a voice will gain a momentum by using the gravitational field of parody. It will find itself propelled, slingshot fashion, into the orbit of another distant timespace. We are back on board Jessie Watkin’s ship and his poignant try-outs at being brave. From here, parody, in the context of the Patient Chronotope, can be expressed as a healing or a regenerative force. This potential is not lost on Caudill. Observing that collectively, patients tended to support the personal role of their fellow patients, he gives as an example of two patients who serve their community with commentaries closely connected to the social activities of grotesque realism:

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Mr Brown’s imitations of the doctors, nurses and other patients were a real source of catharsis for the group; and Mr Davis’s immature explosions toward the staff provided vicarious satisfaction for others, while his expertise at bridge and at solving cryptograms was a source of recreation.86 Of course, it could be argued that parody is common to all people who gather together to offset the negative impact of their experience. Groups as diverse as disgruntled soldiers or resentful school children have long traditions of parodying their controlling authorities. Yet, from Caudill’s observations, parody would almost seem to be a way of life. On this landscape life itself is bi-directional. There are even two levels of care, official and unofficial, with one being a parody on the other, but both, of course, declining to enter into dialogue with the other: During the night, Mr Sullivan had had an anxiety attack and had been taken care of by Mr Brown, who wrapped him in a blanket and rubbed his temples until he went to sleep. When Mr Sullivan awakened again, another patient read to him for several hours. The night nurse, of course, must have observed this behavior. Nevertheless, when a student nurse asked at breakfast the next morning how Mr Sullivan had been, none of the group of male patients would answer her.87 Rosenhan also illustrates the bi-directional nature of this landscape and its strong parodying component: We commonly askedpatients, “How do you get out of hospital?” Never did a patient advise, “Just tell them you ’re fine now, and you want to go home”. They recognised they would not be believed. More commonly they encouraged us to be cooperative, patient, and not to make waves. Sometimes they recommended a special kind of indirection: “Don’t tell them you’re well. They won’t believe you. Tell them you’re sick, but getting better. That’s called insight, and they ‘ll discharge you!’’88 In sum, it can be seen that parody guides and gives life to specific forms of ideology. On the wider social landscape it underpins the different directions of care and it gives the means of conducting unofficial encounters. Always provoking and always seeking an audience, parody patrols the collective voice, finding its home in many scattered and fragmented ideologies. It also offers a site for the testing-out of interminable inner dialogues. A lone and isolated voice is tempted with an accessible way to represent the world. Out on the bleak edges of its orbit are the entry points to new sites of social potential. These points of entry are heavily decorated with laughter and caricature and loopholed with other alternative directions. One can go forward, retreat, hesitate, go round again, or even laugh in its

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face. Parody’s apparent simplicity and lightness exists to make passive the underlying fears of everyday events. For, in accord with the grotesque cartwheel, this is a space for the testing-out of truths and for the glimpsing of more distant timespaces.

AN ‘I-EXPERIENCE’ OR A ‘WE-EXPERIENCE’? The prevalence of parody in Caudill’s transcripts is a characteristic of the ‘ we-experience’89 of the Patient Chronotope. By the ‘we-experience’ I mean the gravitational pull of the chronotope’s ideological centres. There is an undoubted negative aspect of parody that is well capable of generating new peaks of consciousness and then falling back on what it sought to escape from. After all, the official pressures on patients to oblige and to be content to reside within the static region of the halted cartwheel are enormous. Some of these patients may well choose to withdraw into the ‘I-experience’ of inner dialogues that are beyond the range of social orbit. For them the ‘we-experience’ of the social other seems fraught with exhaustion and unfulfilling encounters. More preferable to them are Bakhtin’s ‘internally persuasive discources’90 with all the ‘dreams and visions’ that provide ‘instructions to heroes, telling them what to do.’91 In such dialogues there is great comfort and companionship to be gathered from the arrangement of delusions and from all the unexpected dialogues with hallucinations. In fact, what better way of becoming a hero than for the CIA to consider yourself valuable enough to be selected for the implantation of probes into your ears. Yet, in their own way, the dialogues of the ‘I-experience’ are continually given over to the testing-out of truths. They are persuasive enough to inject life into a non-social existence. Such unofficial voices, both heard and unheard, have gained their own unique position on this landscape. However, the overwhelming ‘we-experience’ of the Care Chronotope - who must treat and manage the carriers of these dialogues - the content of these unheard voices have long been judged as banal or framed in simplistic options of good and evil. Jaspers’s voice is ever present in this chronotope. We can hear the echoes of his voice within the advice given in Felix Post’s The Clinical Assessment of Mental Disorders. Post’s position as a busy practitioner means that any potential for dialogue over against the demands of official time is deafened in advance: There is in the great majority of instances no need to be anxious about wasting precious time by allowing the speakers to ramble on. Most people are so unaccustomed to being permitted to talk without interruption that they will soon fall silent. By then it will have become

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clear to the doctor whether [...] the informant has begun to go round in circles during his account.92 Caudill gives two extremes of the ‘I-experience’ in patient life. The first involves a ‘Miss Ford’, a rather reserved young woman, who continually denies her status as a patient. She thinks of the clinic as ‘just like college’ and treats her psychiatrist as a lecturer whom she expects to give answers to her questions. She makes no attempt to support the other patients and treats them all in a derogatory fashion. Caudill considers her as ‘aggressive, snobbish and class conscious.’ Consequently, she earns the hostility of the patient group who reject and isolate her. Miss Ford’s refusal to settle for an acceptance of patienthood largely depends on the strength of her own inner resources. I hope they proved adequate to her journey. At the other extreme Caudill encounters those patients who decline to be taken in by the pull of a ‘we-experience:’ Hers [Miss Ford] was a very different type of isolation from the occasional self-imposed withdrawal of Mrs Gray, which was respected by the patients, or from the complete isolation imposed on himself by Mr Reed. Through physically present on the ward, Mr Reed never entered the social field of the patients, who held an entirely neutral attitude toward him and scarcely recognized his existence.93 I reject the notion that patient conversation is some form of pantomime language, little more than a regressed or childlike register. Many of the psuedopatients came to believe that their assumptions about patients being incapacitated across the full social spectrum are wildly off the mark. All eight of Rosenhan’s researchers discovered that the patients who they had spent so much time with ‘were sane for long periods of time – that the bizarre behaviour upon which their diagnosis were allegedly predicated constituted only a small fraction of their total behaviour’.94 For polyphonic travellers, given to spending time in cafeterias and bus stations, it is a commonplace to find patients diagnosed with profound thought disorders or severe cognitive dysfunctional states, to be otherwise purchasing refreshments or dealing with complex transactions at the Post Office. During the great floods of the 1980’s in Kansas, one psychologist is astonished to see chronic schizophrenic patients – some of whom had been hospitalized for over twenty years – not only loading and placing sandbags with the rest ofus, but effectively supervising us in the loading and placement of bags. The patients kept this up for several days; then, once the emergency had passed, they resumed their back-ward existence.95

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It will be seen that the social values expressed by patient fellowship can often be more advanced than those found in the ordered world. Caudill is surprised to find an absence of malicious gossip among his patients. A ‘greater tolerance’ of a wider range of behaviours is much in evidence, and he becomes aware that the outside conflicts of class and racial discrimination are, more often than not, held in a form of cultural suspension. Throughout the psuedopatient world this special sense of respectfulness towards other patients is as notable as it was in the experiences of the practitioner patients. Reynolds: One patient approached another who was seated quietly. He asked, “I saw them giving you a shot the other day. Do you get more than one a day?” The other patient just stared at him. He did not respond verbally at all, and after a minute the first patient wandered away. Again, the patient in good contact, the patient who knew the customs of the ward, did not interpret this inaction as a personal rejection.96 Such dignity seems to prosper in those structures not provided for by the Care Chronotope. Dialogues occur in places, unheard and unseen by the staff that appear to be of the greatest significance to the patient. It will be recalled that when Deane was first admitted to his ward he had found the conversation of another patient ‘wearying.’ But as soon as he had entered through the gates of the Patient Chronotope he was able to converse ‘eagerly and felt a great fellow feeling with him’. Here would seem an appropriate point to pull together the two themes of parody and the shifting orbits of the ‘we-experience.’ Parody is so prevalent within the patient voice because it is itself a homeless voice and in the quiet recesses of the clinic it finds spaces where it can breathe and be alive. If anything, parody is permissible by default because of the Care Chronotope’s disinclination to enter into any dialogue at this level. The banter in which parody finds its home is considered peripheral to the concerns of clinical management. Yet the sense of a permissible parody is immediately evocative of the connection between parodic speech and the licensed carnival. As with all carnival activity Caudill’s parodic transcripts are entirely dependent on a world they are apparently subverting. The dialogues have meaning only in relation to an understanding of the conventional norms of the hospital. Parody flourishes in one timespace only because another ignores it. It follows on from this disinterested permissibility that parody’s voice comes alive in the temporary and unofficial intervals in clinic life. Reynolds recalls that ‘particularly in the early morning’ the patients gathered together in a room to ‘kill time before breakfast’ and these unofficial assemblies were often entertained by impromptu performances. On one morning a ‘Mr S’ engaged another:

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[I]n which they made free associations to each other’s word salads. They were smiling and laughing during the course of the game. It was ifthey were aware, as was everyone else, that a game was in progress.97 Such revealed spaces add a rich complexity to the landscape. In their short durations these spaces contain living performances that gather together diverse voices into an intense ‘we-experience.’ Most of the psuedopatients report that the Care Chronotope, despite jogging along in the closest proximity, is generally unaware of this collective aspect of patient life. Any recognition of the patient world as a meaningful social world is considerably weakened by the insistence of interpreting patient behaviour solely in biographical and individual terms. Caudill: Both doctors and nurses, seemed unacquainted with many aspects of life in the patient group, and dealt with each individual as a separate entity in administrative details as well as in therapeutic matters. 98

PSEUDOPATIENTS: SUMMARY DISCUSSION In gathering together the experiences of pseudopatients, it should be noted that all but one or two were established professionals. The majority were recognised practitioners in mental health. In their research projects some were well acquainted with the wards they lived on and some made no secret of the fact that they were researchers acting out the role of a patient. Most, however, chose to conceal their identities and live entirely as a patient admitted to a ward. Yet, within durations of time that are described as sudden or immediate, all of these people underwent profound emotional and physical reactions. William Weitz, the clinical psychologist, who spent twenty-four hours on a ward, was almost desperate to be released at the end of his stay. What happened in this relatively short period of time? What caused Weitz to summarise his stay as a ‘very terrifying and stress-producing experience?’ Why did Bill Deane, the assistant professor of sociology, well known to the staff and patients alike, break down ‘in sobs’ upon his release? The sheer ‘unpleasantness of the experience’ meant that he was to spend some days recuperating under considerable tension: ‘I was restless and tense. I drank innumerable cups of coffee and smoked endlessly [. . .] I slept badly and was bothered by nightmares.’ Even the more modest eight-hour projects of the student nurses were to leave most ‘feeling unusually tired at the end of the day. A few had headaches.’ Perhaps the most obvious distinguishing feature of the psuedopatient’s reaction – and, indeed, the practitioner patient’s reactions – is their wildly

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altering emotional states. Many are clearly unprepared for this reaction and some express their shame. The intensity of their reactions cannot be denied. Weitz, whose moods swing between ‘anger and loneliness, detachment and boredom,’ explains that all of these feelings ‘were very genuinely felt.’ With some alarm we saw how David Reynolds, an ex-naval officer and an experienced field anthropologist, became rapidly consumed by feelings of anger, unworthiness and dejection. From my earlier observations on the grotesque cartwheel and on the properties of chronotopes I propose that these mood swings must be enfleshed and seen as standings on the psychiatric landscape. This bodily position arises from an overbearing sense of abandonment and a sudden loss of familiar chronotopic markers. The transformation, like that experienced by Lucius, is a real one. The profound disorientation suffered by the psuedopatients is akin to a traveller who is plunged, with little preparation, into the times and the spaces of an unforeseen alien culture. These are real and living timespaces entirely different to the ones they have only recently left. The psuedopatients are lost in a wilderness between two boundaries of meaning and they are urgently marking time. At times they frenziedly flail at their environment or their bodies just surrender to apathy and they submerge themselves listlessly into dayroom armchairs. There are frequent bodily explosions of anger and bitter accusations of betrayal directed towards their colleagues and spouses. The recognition of no-man’s-land is vital to understanding the enfleshed nature of these journeys. I restate my original premise that the prevailing countenance of the Patient Chronotope is one of passivity and acceptance, while, in contrast, the hallmarks of the Care Chronotope are ones ofpurpose and an idealisedfuter. Swaying uneasily between these two timespaces is a turbulent mid-zone that lends itself well to the ambivalence of reciprocated encounters with grotesque imagery. Here in this region we make contact again with the reciprocal dance of the primary position as the psuedopatients make repeated encounters with grotesque forms. This is a strange dance indeed and one the neo-classical body is well defended from. What happened to the psuedopatients is that they came to embody all the incongruities that are at large in this region. There was no escape to a secondary position. Not only did real fear and genuine apathy ebb and flow through their veins but the same confusion penetrated into the most rational considerations that only recently they held with so much certainty. ‘That night,’ says Rockwell, ‘as I lay in my bed all of the childlike stereotypes about madmen and lunatics came back.’ Under these conditions it is no small wonder that the psuedopatients strike out towards the nearest living voice. As readers of these exploits we are in a curious dialogical position. We hear the voices of the psuedopatients but we don’t really know them. Indeed

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they don’t know us. But as readers and as psuedopatients we can both consider ourselves as individuals made up of flesh and blood. All the transcripts that I am refracting through this book were made at least three decades ago. Some of the psuedopatients are now dead. Some of you reading about their activities were not even born then. It was a different time and a different space to the one I occupy now and the ones you, as another reader, are occupying now. Dialogically, these distances can also be enfleshed and a critique mounted in the way the Care Chronotope justifies the present by reference to the past. It is a voice that utters that these experiences could not happen here and now. Much of the criticism that rained down upon Rosenhan implied that his team had more than likely come across an unrepresentative and poor standard of care. These critics, and there were many, insisted that Rosenhan’s project could not be of their timespace. One example is in Helen Rabichow and Mary Pharis’s99 hostile assault where they assume that the staff in Rosenhan’s twelve hospitals were ‘badly trained [, . .] devoid of warmth, empathic inclinations, and respect of their charges.’ Of all the projects I have examined only one (Goldman, Bohr and Steinberg) chose to place a researcher on an 80-bedded ‘dilapidated’ ward that is ‘insect and rodent infested.’ However, Rosenhan, along with Deane and Winkler, rules out the quality of care as a contributing factor. It was more usual for the psuedopatients to be assigned to the highly regarded end of psychiatric practice. In fact, Rosenhan describes his hospitals as ‘the excellent public ones and the very plush private hospital.’100 And he goes further in countering the factor of the quality of care. The ‘overwhelming impression’ from his project was that staff were ‘people who really cared, who were committed and who were uncommonly intelligent’ but who ‘sometimes painfully failed.’ There is a mischievous sting in the tail to Rosenhan’s counter argument. Before his seminal paper was published Rosenhan took the opportunity to outline his research in a lecture given at a prominent teaching hospital. At the end of his talk he is challenged by an affronted audience to replicate his experiment at their hospital. Rosenhan obliges and he forewarns the assembled practitioners that at some point during the next three months, one or more psuedopatients would attempt to gain admission to their hospital. Unfortunately, due to an illness, the assigned psuedopatient fails to materialise. But in the meantime, over the three-month period, different levels of hospital staff suspect more than ten-per-cent of their admissions to be impostors. Another way of understanding the experience of those entering into a different chronotope is to expand upon Professor Redlich’s original question: What is it that contributes to the processes of recovery in mental hospitals? The overview we have gained from the adventures of the psuedopatients

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offers a novel position to assess the contrasting relationships to those adrift in the mid-zone that exists between the two chronotopes. Redlich’s question can be re-phrased thus: What is the contribution of the Care Chronotope and the Patient Chronotope to those who find themselves abandoned in noman’s-land? Erving Goffman,101 ever alert to the way performance affects perception, gives an insightful perspective on no-man’s-land as seen from the world of the Care Chronotope. He writes at length of the ‘betrayal funnel’ of the ‘prepatient stage’. In a similar manner to our narratives the genuine patient begins his or her career with a bundle of emotions that Goffman expresses as ‘abandonment, disloyalty and embitterment. ’102 The trust in those closest to the patient becomes severely shaken as husbands or wives are drawn into the management of the admission. Guises are adopted by all concerned in the interests of smoothing the procedure through. The spouse tries not to cry, the psychiatrist would prefer not to have a scene, and the more experienced police officers find it easier to support an admission with ‘kindly words and a cigarette,’103 What is at work here is a powerful and deceptive interplay. We are witnessing Foucault’s psychiatric ‘secret conspiracy’ in which ‘nothing or no one is really responsible.’104 Provided the patient is ‘reasonable decent about the whole thing’, the process should run smoothly. But what we have here is a demonstration of reassurance directed towards the Care Chronotope. In its spaces – the admission suites, the screening interviews, the various admission rituals – are activities that are designed to shield all but the patient from the magnitude of the process. Any expression of an extreme emotion on the part of the patient is to be anticipated and neutralised accordingly. Goffman’s betrayal funnel is a description of the attempt to professionally manage the grotesque dance of the primary position. A dance that is experienced as a wholly solitary event by the psuedopatients and the practitioner patients alike. By seeking to orchestrate this dance, the Care Chronotope, ever distrustful of ambivalence, is attempting to negate a primitive mid-zone and replace it with a modem, artificial, procedural pathway. And, further, there is no recognition from Goffman of any immediacy in his betrayal funnel. He is content to comply with widely held assumptions that all this journey is a gradual process. For him assimilation into the patient world is unhurried and the onset of institutionalisation will occur ‘only if the inmates stay is long.’105 His observations are in keeping with the generally accepted beliefs that extended time is necessary for patients to absorb a new timespace. Russell Barton’s acclaimed study, Institutional Neurosis, not only claimed this enfleshed timespace as a ‘disease’ but went on to presume its clinical features – ‘apathy, loss of interest, apparent inability to make plans for the future, [and] lack of individuality’106 -tooksome ‘two years’ to develop.

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The step-downs I have taken in this landscape suggest an entirely different range of duration. Encounters and shifts within no-man’s-land take place with a sense of suddenness. Here things happen in seconds and minutes rather than months. Many of the narratives of the previous chapters have referred to being rescued by the Patient Chronotope. Time and space is different here. The ‘disease’ that Russell Barton describes is the enfleshed expression of another way of life. Here there is no compulsion to transfer the surplus imagery of another onto a progressive and linear arrangement of time. Patients pass on from one revolving voice to another in a sloweddown time expressed in bodily form. During the degenerative or downward aspects of a movement words seem to elicit little response. Minimal or fleeting physical contact seems the most appropriate form of contact. For me, quite the most heartening feature of the Patient Chronotope is that the communities of patients, and all the spaces that their voices inhabit, are visible to each other. In each other they recognise that blood flows in their veins and that their own ‘time, as it were, thickens, takes on flesh, becomes artistically visible.’107 This chapter commenced with a consideration of Lucius’s transformation into an ass and his descent into low life. For the purpose of developing the concept of polyphony, Lucius – ‘a would-be man from another world’108 – represents a new and a creative means of navigating the psychiatric landscape. There are many parallels to be seen in the journeys of Lucius and the narratives of the previous two chapters. Encounters were governed by chance, and only recalled later in scattered and fragmented episodes, rather than in any ordered sequence. Their descent into ‘low life’ attuned both sets of adventures to the ‘underside of real life.’ And because the standing of Lucius and the psuedopatients merited so little consideration, their narratives are coloured by events that ‘could not occur in the eyes of the world.’ The unfixed nature of their identities made them privy to dialogues that are simultaneously horrifying and fascinating. Here, reason collapses into unreason, the visible into the invisible, and care into terror. Like Lucius the psuedopatients followed a path through familiar territory. For the psuedopatients this territory became one of the most dangerous regions of the psychiatric landscape. Few choose to venture into this forgotten and uncultivated brushland. So unfamiliar is this terrain that it is extremely difficult for those who wander here to begin to find their bearings. Even to get this far the traveller has had to surrender all the security of a well-known means of travel. He or she is rapidly overwhelmed by feelings of abandonment and betrayal. There are hellhounds that hunt here and they delight in making unexpected appearances.

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Truly, this is the least known and the least visited part of the landscape. Therefore, it is the most interesting of places to go. A further and final step down is required. Leff, J.P. and Issacs, A.D., Psychiatric Examination in Clinical Practice, Oxford, Blackwell (1990). 2 FTC: pp111-29 3 Bakhtin draws parallels with the Early Church Father’s practise of purification through suffering in the pattern of Lucius’s journey. See FTC: p115. 4 Hay, G.G., ‘Feigned Psychosis – A Review of the Simulation of Mental Illness’ in British Journal of Psychiatry, Vol. 143, ( 1983) pp8-1 0. 5 The notion of ‘informed consent’ did not merit ‘serious examination until around 1972’. See Beauchamp, T.L. and Childress, J.F., Principles of Bionmedical Ethics, Oxford, Oxford University Press, (1989) p74. 6 Rosenhan, D.L., ‘On Being sane in Insane Places, in Science, Vol. 179, (1973) pp250-8. 7 Science, Vol.1SO, (1973) pp356-69. 8 Fleischman, P.R., ‘Letters to the Editor’, in Science, Vol. 180, (1973) p356. 9 Thaler. O.F., ‘Letters to the Editor’, in Science, Vol. 180, (1973) p358. 10 Millon, T., ‘Reflections on Rosenhan’s “On Being Sane in Insane Places”’, in Journal of Abnormal Psychology, Vol. 84, NO. 5, pp456-61. 11 Crown, S., “’On Being sane in Insane Places”: A Comment from England’, in Journal of Abnormal Psychology, Vol.84, No.5, pp453-5. 12 Weiner, B., “’On Being sane in Insane Places”: A Process (Attributional) Analysis and Critique’ in Journal of Abnormal Psychology, Vol.84, No.5, pp433-41. 13 Dingwell, R., ‘Ethics and Ethnography’, in Sociological Review, Vol.28, No.4, (1980) pp87 1-9 1, and Bulmer, M., ‘The Research Ethics of Pseudo-Patient Studies: A new look at the merits of covert ethnographic methods’, in Sociological Review, Vol.30, No.4, (1982) pp632-46. 14 Redlich, F., ‘The Anthropologist as Observer’, in The Journal of Nervous and Mental Disease, Vol.157, NO.4, (1973) pp313-9. 15 Rockwell, D.A., ‘Some Observations on Living in’, in Psychiatry, Vo1.34, (1971) pp21423. 16 Redlich, F.,(1973) p3 15. 17 Rosenhan, D.L., ‘The Contextual Nature of Psychiatric Diagnosis’, in Journal ofAbnormal Psychology Vol.84, No.5, (1975) pp462-4. 18 Deane, W.N., ‘The Reactions of a Nonpatient to a stay on a Mental Hospital ward’, in Psychiatry, Vol. 24, (1961) pp61-8. 19 Mueller, B.S. and Sherman, C.C., ‘Nurses Experiences as Psychiatric Patients’ in Hospital and Community Psychiatry, Vol. 20, No. I, (I 969) pp40-1. 20 Goldman, A.R., Bohr, R.H. and Steinberg, T.A., ‘On Posing as Mental Patients: Reminiscences and Recommendations’, in ProfessionalPsychology, Vol. 1, (1970) pp42734. 21 Winkler, R.C., ‘Research into Mental Health Practice Using Pseudopatients’, in The Medical Journal of Australia, Vol. 6 I, No. 2, (1974) pp399-403. 22 Mueller, B.S. and Sherman, C.C., p40. 23 ibid: p40. 24 Weitz, W.A., ‘Experiencing the Role of a Hospitalised Psychiatric Patient: A Professional’s View from the Other Side’ in Professional Psychology, Vol. 3, (1972) pp15 1-4. 1

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ibid: pl52. Mueller, B.S. and Sherman, C.C., p40. 27 Rosenhan, D.L., (1973) p252. 28 Jung, C.G., Memories, Dreams, Reflections, London, Fontana, (1961) p3 12. 29 Deane, W.N., p62. 30 Rockwell, D.A., ‘Some Observations on Living in’, in Psychiatry, Vol. 34, (1971) pp21423. 31 ibid: p2 17. 32 Reynolds, D.K. and Farkerow, N.L., Suicide: Inside and Out, Berkeley, University of California Press (1976). 33 Again the reality of feelings should not be underestimated. The Guardian of 3 October 1998 reports on a publicity stunt of a group of dignitaries and celebrities invited to spend a night in the cells of the newly re-built wing of Brixton Prison. One celebrity, Ulrika Jonsson recalls how the unfamiliar footsteps, the noises of the night, and the fear that someone was ‘peeping in on her’ made her seriously contemplate suicide. “Once you’re in a cell that’s when things start to get frightening. The second the lights go out, that’s it, the fears start coming”. 34 Reynolds, D.K. and Farberow, N.L., p 102. 35 Rockwell, D.A., p219. 36 Deane, W.N., p62. 37 Meuller, B.S. and Sherman, C.C., p41. 38 Rockwell, D.A., p220. 39 Goldman, A.R., Bohr, R.H. and Steinberg, T.A., p429. 40 Caudill, W., Redlich, F.C., Gilmore, H.R. and Brody, E.B., ‘Social Structure and Interaction Processes on a Psychiatric Ward’, in American Journal of Orthopsychiatry, Vol. 22, (1952) pp3 14-34. 41 Winkler, R.C., p400. 42 Goldman, A.R., Bohr, R.H. and Steinberg, T.A., p429. 43 Rockwell, D.A., p217. 44 Reynolds, D.K. and Farberow, N.L., p104. 45 Rockwell, D.A. p217. 46 Winkler, R.C., p402. 47 Mueller, B.S. and Sherman, C.C., p40. 48 Reynolds, D.K. and Farberow, N.L., pp83-4. 49 Rosenhan, D.L., (1973) p253. 50 SG: p151. 51 de Swaan, A., The Management of Normality: Critical Essays in Health and Welfare, London, Routledge, (1990) pl85. 52 Rockwell, D.A., p222. 53 Deane, W.N., p67. 54 Reynolds, D.K. and Farberow, N.L. p114. 55 ibid: ppI 15-6. 56 SG: p170 57 Chamberlin, J., On our Own: Patient-Controlled Alternatives to the Mental Health System, London, MIND, (1988) p109. 58 RAHW: p10. 59 I am reminded here of the uncompromising voice of the 14th century mystic, Ibn Kaldun: ‘The mad have cast upon their tongue words from the unseen and they tell them’. 25 26

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At the end of the Caudill experiment (see below) the project supervisor gathers together the patients in the clinic to inform that one of their number had in fact been a psuedopatient. They ‘received the news calmly, I believe, with a certain glee. I had the feeling they were amused rather than dismayed over Caudill’s method’. Redlich, F.C. ‘The Anthropologist as Observer’ in The Journal of Nervous andMental Disease, Vol. 157, No.4, (1973) p3 15. 61 PND: p59. 62 Caudill, W., Redlicli, F.C., Gilmore, H.R. and Brody, E.B., ‘Social Structure and Interaction Processes on a Psychiatric Ward’, in American Journal of Orthopsychiatry, Vol. 22, ( 1952) pp3 14-34. 63 Redlicli, F.C., ‘Forward’ in Caudill, W., The Psychiatric Hospital as a Small Society, Cambridge, MA, Harvard University Press, (1958) p ii. 64 ibid: p iv. 65 Caudill, W., The Psychiatric Hospital as a Small Society, Cambridge, MA, Harvard University Press, (1958). 66 The Journal of Nervouse and Mental Disease, Vol. 157, No.4, (1973). 67 Redlicli, F.C. (I 973) p3 17. 68 Rosenhan, D.L. (I 975) p464. 69 Lodge, D., After Bakhtin: Essays on Fiction and Criticisin, London, Routledge, (1 990). 70 PND: p54. 71 RAHW: p39. 72 Macdonald. M .. Mystical Bedlam: Madness, Anxiety and Healing in Seventeenth-Century England, Cambridge, Cambridge University Press, (1981) p1. 73 RAHW: p39. 74 Sass, L.A., Madness arid Modernism: Insanity in the Light of Modern Art, Literature and Thought, New York, Basic books, (1992) p112. 75 Caudill, W., et al., (I 952) p318. 76 PDP: pl85. 77 Morson, G.S.. ‘Parody, History and Metaparody’, in Rethinking Bakhtin, eds. Morson, G.S. and Emerson, C., Evanston, Northwestern University Press, (I 989) pp65-6. 78 PND: p53. 79 PDP: p1 14-7. 80 Caudill, W. et al., (1952) p322. 81 PND: p59. 82 Caudill, W. et al., (1952) p323. 83 Hutcheon, L., ‘Modern Parody and Bakhtin’, in Rethinking Bakhtin: Extensions and Challenges, eds. Morson, G.S. and Emerson, C., Evanston, Northwestern University Press, (1989). 84 PDP: p1 14. 85 Reynolds, D.K. and Farberow, N.L. p128. 86 Caudill, W. et al., (1 952) p329. 87 ibid: p330. 88 Rosenhan, D.L., (1973) p254. 89 MPL: p88. 90 DiN: p342. 91 FTC: p117. 92 Post, F., ‘The Clinical assessment of mental disorders’, in General Psychotherapy: Handbook of Psychiatry. Volume I, Cambridge, Cambridge University Press, (1983) pp210-220. 93 Caudill, W., et al., (1 952) p317.. 60

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Rosenhan, D.L. (1973) p252. cited in Sass, L.A. p24. 96 Reynolds, D.K. and Farberow, N.L. p138. 97 ibid; p127. 98 Caudill, W., et al, (1952) p326. 99 Rabichow, H.G. and Pharis, M.E., 'Rosenhan was Wrong: The Staff was Lousy', in Clinical Social Work Journal, Vol.2, No.4, pp271-8. 100 Rosenhan, D.L. (1973) p257. 101 Goffman, E., Asylums, Harmondsworth, Pelican, (1961). 102 ibid: p 125. 103 ibid: p13 1. 104 Foucault, M., Madness and Civilisation,(1961) p13. 105 Goffman, E., p23. 106 Barton, R., InstitutionalNeurosis, Bristol, John Wright & Sons, (1959) p62. 107 FTC: p84. 108 The quotes in this paragraph are taken from FTC: pp1 15-22. 94 95

Chapter Nine

The Pseudopatient

“I myself,” says Lucius, “remember my sojourn as an ass with great gratitude, for having suffered the turns of fate under cover of this animal ’s skin I have become, if not wiser, at least more experienced. ” M.M. Bakhtin1 If I am to call myself a polyphonic traveller I must first, reveal more of my characteristics and second, demonstrate a willingness to apply polyphony’s methods on the psychiatric landscape. After all, if I am to advocate to others the merits of an abstract alibi then I have every responsibility to apply them to my own body first. And this is not always easy. Like the practitioners before me I too am a late twentieth-century being and I find it equally difficult to shed the disciplinary comforts of the neo-classical body. As a polyphonic traveller I do not have a centre, or a beginning or an ending. And in this statement it will be seen that I share many similarities with the great and ancient genre of parody. We both share the same characteristic of homelessness that leaves us without a fixed form of discourse or a recognisable stability that is peculiar to ourselves. We each owe our definition to the ability to borrow the qualities we encounter in the voices of others. Thus the vague outlines of my own body and the unformed voice of parody are capable, in the way we move into positions alongside other voices, of entering into a wide variety of dialogues. Through this manner of travel aspects of geography are revealed that are all but invisible to the busy bodies who must march to the beat of the asylum clock. Here, I have the freedom to forage about in regions that are there but not there. If 181

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you do see me you will recognise me by the way I potter about among different degrees of truth and differing levels of reality. I have little ambition to impose a form upon the events that unfold around me. I have no particular brief to resolve problems arising from these events for I am more committed to live-through them and even participate in the immediate reality of the voices that are making up the event. I strive (and I say again that this is not easy) to respect the other because the other is other. Rather than seeking the management of another I prefer to put my trust in the potentials of a dialogue when it is left to itself. This is not to claim for myself a passive stance in every dialogue. My voice has every right to be as angry, or as compassionate, or as scared as anyone else’s. Admission as an in-patient to a psychiatric hospital can be accomplished in one of two ways. In nearly all cases the would-be patient has to do something. Nowadays, English psychiatry is preoccupied exclusively with the management of behaviour. One cannot, for instance, show up at reception and ask for one’s ego ideal to be re-primed or complain that one’s lover is finding you irritating and believes you need treatment. For psychiatry the worried well are not to be encouraged. Alternatively, if you shout in the marketplace or misbehave badly at the bus station you can secure a fairly rapid admittance. This method, however, generally involves the police and if you don’t get it exactly right you could end up before the magistrates. The more respectable method is to be referred to the clinic by a physician. I wanted to follow this latter process because I felt I needed the support of a gatekeeper whom I could discuss and entrust my project to. Ideally I needed to meet a practising psychiatrist who would greet my request with some enthusiasm. Like everything else this was not easy. I remember the Ringmaster who right at the beginning of the introductory lectures had stood before us and formed his thumb and forefinger into a circle. This, he indicated, is the tiny percentage of practising psychiatrists who do not accept the medical model of madness. No one laughed. It wasn’t a joke. What I am going to say next is awkward. This is partly due to the pledge of secrecy I gave to people who came to know about my project. It is also partly due to the subsequent reaction of my gatekeeper. Can I just be allowed to say that there are some very creative people out there and I eventually encountered a person who understood the spirit of my enterprise? Unfortunately, he and I (in different ways) were to underestimate the strength of feelings that are invoked by deliberate acts of deception. Very soon after the project was over he broke off contact with me. But I am going to stay with the enthusiasm of our initial meetings. I had wanted to be admitted to a hospital but it became obvious that administrative constraints were going to play a major part in my admission. My gatekeeper

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felt that becoming an in-patient in a hospital would necessarily involve the collusion of at least one senior manager. And such co-operation would not be forthcoming. Instead, my gatekeeper proposed that I should be admitted to a satellite hostel where I could attend for an assessment visit and subsequently be admitted as an in-patient. He had in mind a 19 beddedclinic-cum-hostel – let me call it The Hawthorns – located on the edge of a city in the Midlands. The Hawthorns was very different from its parent hospital. It had a high reputation for its approach to the mentally ill. Its thinking was modem; there were no uniforms, the staff ate with the patients, and there was a reluctance to rely on tranquillisers. I insisted in maintaining a covert presence throughout my stay. I felt that any prior knowledge of my presence would only cause the staff and the patients to treat me differently and, consequently, my observations would be no more than the record of a set of responses to a false status. With these conditions in mind a plan of action was agreed. To deflect the inquisitive demands of administration it was decided that I was to become a down-andout of no fixed abode who had drifted into a boarding house. On top of this guise I added in the quality of depression. Like the psuedopatients before me I knew what is was like to feel low and I was reasonably confident I could re-assemble myself to present a convincing image of an itinerant depressive. I modelled my image from the memory of a depressed gentleman I, as a practitioner, had once admitted to a psychiatric ward. He had been very quiet, utterly undemanding, and only too willing to co-operate in whatever was asked of him. Like him, I too wanted to cause no trouble for anyone. We agreed that I was to book-in at a city centre boarding house known to have good links with mental health services. Once I was there, I was to come to the attention of the gatekeeper, who would express his professional concern at my mental state and refer me to the Hawthorns. In between my assessment visit and the admission I was to return to the boarding house for a couple of days. We discussed some likely dates and, in the meantime, I set about taking on the voice of homeless dejected tramp. I let my hair grow, I shaved unevenly and I grew some very unfashionable side bums. I bought some clothes from a local market that were to double as my pyjamas and everyday attire. There were no problems booking in at the boarding house. But it was a grim place indeed. The only bath I was aware of contained the discarded and sodden remnants of someone else’s clothing. The thin partition walls of the rooms permitted the noise of unrelenting pop music to seep into my room. My stay here was spent in vagrant circumstances. There was scarce opportunity for conversation, and the need for speech, along with a need for a personal bodily freshness, speedily dissolved.

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It will be remembered that just as soon as Lucius was transformed into an ass he found himself standing on familiar landscape. But his new identity had equipped him with an unfamiliar set of temporal and locational coordinates. From here onwards the geography of the landscape before him would no longer unfold in its usual linear fashion. Events will now occur through a series of temporally segmented frames. What follows is a diary of things that happened to me. It was written up within a few days of the project’s conclusion and is largely unchanged. This is how it appeared to me. A life seen through the eye-holes of a mask.

THE VISIT A schizophrenic out or a walk is a better model than a neurotic lying on the analyst’s couch. Breakfast is cornflakes, bread and margarine, and tea. I emerge from the boarding house at 9.30am. About an hour’s walk to the Hawthorns. Feel very scruffy, unkept, unattractive, and dirty. In my pocket I clutch onto the piece of paper giving me directions. I don’t want to look at people. Keep my head down. Just enough vision to avoid collisions. Shuts others out. I’m made aware of how much eye contact with car drivers a pedestrian is required to make in order to cross a road. I feel some relief, and a great deal of uncertainty, when I eventually arrive at the driveway to the clinic. A man is walking down the drive towards me. I know intuitively that he is a patient by the way he walks. A harmless promenade that is not really going anywhere. I show him my piece of paper and mumble something about the Hawthorns. “Yes”, he says. “Just go there”. He points to the building at the end of the drive. There are several cars parked along the drive. I walk up the steps that lead to a once imposing door. I press the bell and I hear a distant ping pong. Nothing happens. I stand there. I realise I don’t want to be seen. Some time passes. I press the bell again. Ping pong. Nothing happens. No one comes. Some more time passes. From the glare of the doorway I can see into the darkness of the vestibule through the glass on the door. Realising this space will lessen my visibility I push the door open and I’m standing in a small hallway. Before me is a glass fire door leading into the hostel itself. To my left is a large notice board and on my right a few stems of

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fake flowers are leaning in a comer. Two other doors lead off from the hallway. On the wall next to the notice board there is a telephone. It starts to ring. A woman pushes through the fire door and looks at me as she lifts the receiver. I stand there looking sheepish. In the silence of the hallway I am witness to one side of a telephone conversation. I shuffle about uncomfortably. I read the fire regulations on the notice board and I change my weight from one leg to the other. The telephone call ends. The woman replaces the receiver and goes back through the door. I remain in the hallway. I know I should walk through the fire door but it is taking all my resolve just to stay where I am. The walk and the warmth of the hallway have made me hot and sweaty. Some perspiration runs down the side of my face. I feel worried. Really quite scared. My piece of paper is damp and the instructions have smudged. Then the fire door is pushed open and the man from the drive is standing there. Behind him is a woman. I assume the man had fetched a nurse and I am now worried that I am in front of someone who might or might not know the real purpose of my visit. The arrangement of my deception now seems very complex and works to compound my uncertainty. “Ah”, she says. “Oh yes. We were expecting you.” She is very kind and calm. As if on permanent stand by to absorb the most frightening of worries. The nurse takes me through a lounge to the kitchen. We are alone in there. I suddenly tell her that I have an appointment with the DSS at two o’clock and that I feel dreadful. “It’s all right. Do you want tea or coffee?” Tea seems the less troublesome option. I become silent. She lets me hook the tea bag from the beaker and shows me where the waste bin is. I follow her back into the lounge. She introduces me to one or two people sitting there. I cannot look at anyone. My heart seems to be racing. I am trying to contain a feeling of disintegration. The nurse introduces me to Monica who was the woman on the telephone. “Perhaps you can show our visitor around once he has finished his tea?” The nurse turns to me and says: “I’ll call back in a while and then we can have a chat.”

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Language For Those Who Have Nothing I sit down on a chair against the wall. To my left is a table and Monica says: “Let me know when you’re ready and I’ll show you round.” I am glad the nurse as gone. I felt very observed. I sit holding my beaker in two hands. There is no sugar in the tea and I have left the teaspoon standing in the mug. I don’t know what to do with the spoon. I feel incapable of removing and placing it on the table. I don’t want to make waves or attract attention to myself. I take small sips of tea. The handle of the teaspoon taps against the glass of my spectacles. Over in the corner of the lounge the TV is on. Two cheerful presenters are dealing with a variety of everyday interests. From somewhere on the other side of the kitchen is the sound of 60’s pop songs. There are maybe three other people in the lounge. One lady has her leg raised on a footstool. But I cannot sit there gazing around. I just want to retreat. The bedroom of my miserable boarding house feels very secure. I begin to create an arc or a range of limited perception around me. This space is bounded by the back of a settee, some six feet in front of me, and fades into borders running back and forth from my chair to the sides of the settee. In height, my space is waist-high, going from the top of my bowed head to the top of the settee. As I concentrate my vision upon the carpet my personal visibility to others feels to be much reduced. This space is also part of a thoroughfare between the kitchen, the corridor, and beyond. Occasionally, a pair of legs will pass across this space. Some legs have dresses. Others, jeans or trousers. Some have sandals, shoes or trainers. Some walk at different paces. Once, a set of legs was using a walking stick. “When you’re ready,” says Monica. “Tell me when you’re ready and I’ll show you round.” She is sitting to my left at the table smoking a cigarette. I try and lift and my head to nod assent. Difficult to make such a decision. I just want to remain in my arc. I am frightened. I finish my tea. Monica stands up and somehow my beaker is on the table and I’m ready to follow Monica anywhere. The tour is very fast. I can hardly recall the areas I am shown. Upstairs there are some bedrooms and a staff man who is cleaning a sink. I know he is staff because his trousers are neatly pressed and his shoes are clean. Also he his busy. At some point the staff man asks me if I would be staying for dinner. I mumbled a sort of “no”. Desperate to be co-operative I chose what I saw to be the least

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troublesome side of a given choice. Oddly, I can recall vividly a bald patch of worn stair carpet. Monica talks very fast: “This is the bathroom and this is the games room and this is the quiet room”. Then she takes me outside. “It’s all right here”, she discloses. “We have staff and we have clients. We can’t always tell the difference. It’s quite a family really.” Then she asks me suddenly: “Have you been in a place like this before?” “No” I reply. “I thought so. You are very nervous. I was like you when I first came in. I’ve been here for four weeks now. If you need to shout then just come and hit this wall for a while. It’ll still be here when you’ve gone. Come on”. And as we go back in she briefly touches my arm. The contact is wonderful. I am back in my chair. I re-engage with my arc. More noises. Difference in staff and clients is evident in a sense of purposefulness in their stride. Staff paces are faster and busier than others. Cheery noise of chatter. Comings and goings. Mid-morning television. Someone has arrived in the kitchen with a “delivery”. A conversation is taking place as to which invoice must be returned in order that a misplaced item can be recovered. To me this exchange seems to be extraordinarily complex. The participants, a nurse and a deliveryman, seem eminently assured and competent. To my left the nurse who first met me has entered the lounge. She approaches me and asks me to go with her. In the games room there are two armchairs by the window. She asks me how I feel and I reply: “Awful. Very strange. As if I have come down here to cause someone harm”. I start to feel very confused. I’m increasingly troubled in wondering if the nurse knows I am in a role and she is not, or I’m out and she’s in role. Whatever, she goes on to explain how the unit runs. She is very patient but I can only take in the most dramatic aspects of her conversation. She warns me that if I go and get drunk and annoy the neighbourhood then I will be asked to leave. Ironically, she speaks about the need for honesty and the importance of not deceiving others: “Some people feel if they want to talk to voices or abuse themselves then they must do this secretly. All I ask is that if people want to do this then they be open and honest about it with everyone”. There is a powerful and compelling strength in what she says. She writes some words down on the yellow form on her lap. These are my “needs” which I express as just wanting to be left alone. She asks me if I have any questions. I say I have to attend a DSS appointment at two o’clock. This is an

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Language For Those Who Have Nothing untruth but I cling to it. I feel stupid and awkward. Our conversation ends with the nurse looking at her watch and saying it is a quarter past eleven. Quarter past eleven! It seems I have been here forever. We leave the room. Again I have a vivid recall of an encountering an everyday image. This time I notice how somebody has planedoff some of the paintwork on the door to allow it to close more smoothly. I remember exactly – almost intensely – how I placed my hand on this exposed section of wood as I passed through the door. Back to my chair in the lounge. Someone has brought in a tray and there is some cheerful activity around the ritual of serving tea. I think I stood up and put a spoonful of sugar in my beaker and returned the spoon to the tray. And as I sip my tea I return to my space. In my head a dialogue of rapid and anguished exchanges is taking place. “What am I doing here?” “What right have I to deceive these people?” “I don’t want to be here.” “I just want to be left alone.” This inner dialogue compounds the feelings I have of guilt, embarrassment and unworthiness. I am very aware that there are people watching me. I am genuinely drained of any capacity to make a decision. Had somebody popped a couple of tablets in my mouth or began preparing me for ECT I am sure I would have meekly complied. Escape seems possible only within my arc. Down towards my left is a special site in the pattern of the carpet. There is a particular triangle in the pattern that seems tilted out of perspective. The more intensely I gaze at it the more I can make it move. In this way I can shut myself off from anything which is outside of my arc. Suddenly I jump! A staff man has asked me a question for the second time. He has come to sit on the arm of the settee and has lowered his head into my space. “I’m sorry. I didn’t mean to make you jump. If you have an appointment at two o’clock can I give you a lift?” “No. It’s all right. I want to walk.” “You want to walk?” “Yes. I’m sorry. I want to walk.” “OK. I’m sorry I made you jump.” This conversation has shaken me out of my reverie. I begin to rub the side of my head and I almost drop the beaker I am still

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clutching onto. I sip at the cold tea. Someone has switched the TV off and tuned into the local radio station. A politician is being interviewed about his new book. With a lot of effort I stand up and take my beaker into the kitchen. The man from the drive is there and without either of us speaking we both start to wash the cups. Again I experience another intense perception. The plastic coated sink-tidy has seen better days. Because of some underlying rust parts of its plastic coated covering has started to peel away. Gently I lift the sink-tidy up and try to loosen some of the rust. There is something intimately precious about the way I do this. Back to my seat. I am confused. There is another tray of tea. This time it is being supervised by a woman I have not encountered before. She is over to my left and talking to the man from the drive. Although she is not directly addressing me she is somehow including me in her communication. I can put it no better than that. She has made a connection with me and accordingly I have gained some confidence. I do not know if she is staff or a client. I am aware that my intuitive ability to tell the difference between what is rational and what is not has been markedly weakened. The radio is playing some country music. I don’t mind this or even the TV. It seems like a way of measuring out the day. I haven’t watched day time TV in years but I seem to know – in the same way that I know football matches kick off at three on a Saturday afternoon and that Evensong begins at six on Sundays – that these shows occupy a particular time-span across the morning. There are three staff members in the lounge now. One is re-dressing a bandage belonging to the lady whose leg has been raised. Another is mildly teasing Monica about a choice of dress. This is pleasant day time banter. A staff man is talking to a staff woman about his forthcoming days off. As I try to listen to this I’m aware again of how complex this dialogue actually is. Days and dates are bandied about, a reference is made to a holiday, and the meanings of time off and on duty are freely exchanged. I am impressed by the way the staff man over to my right is able to hold such information in his memory.

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Language For Those Who Have Nothing Over to my left the woman who was pouring out tea is now sitting with a couple of people. Just for the briefest second her eye catches mine. Here in my chair I have been twisting my woollen hat between my hands. The twelve o’clock news comes onto the radio. Twelve o’clock! I almost refuse to believe this and wonder if I misheard the announcer. My inner dialogues are again consumed with questions in which I am hardly a participant. “How can I leave this place?” “Surely I cannot just stand up and go?” “Who should I tell that I am going?” “Should I pay for the tea I have drunk?” “And if I do leave should I go by way of the kitchen or out through the door I came in by?” The knowledge that if I did go I could then walk in the drizzle outside was very appealing. I twist my hat some more. I make one or two attempts to put it on and I stand up. Awkwardly I address myself to the staff man who has some off duty to come. The words seem to blurt out of my mouth. “I’m going to go now and I’ll come back on Wednesday.” “Are you sure you don’t want a lift?” He says looking at his watch. “No. No. Its all right, its all right.” “Do they know in the office that you’re going?” This is a complex question to ask of me. “They” and “the office” are quite alien concepts. Space beyond the beyond as it were. “I don’t know.” He begins to stand up and I mumble a goodbye and then I’m out in the afternoon rain. What absolute relief. But it wasn’t over. Ten minutes into my walk and I realise I’m in difficulty crossing a road. I had almost forgotten that there are real rules and responsibilities out here. I had forced a vehicle to brake sharply by stepping out into the road. The driver glared dangerously at me. Then it happens again when I stop by at a shop to buy a hot pie. Suddenly, and way out of character, I am very angry with the shopkeeper when he asks me for an extortionate 80p. I really want to shout at him. Fortunately, I managed to leave the shop and stand outside trying to calm my breathing down. Out here there is no safety net to fall back on or any stand-by dialogue that could explain my misjudgements. Some of those legs that passed through my arc (I recall everyone

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from the waist down or as a voice) were there to act as a safety net for me. On this terrain I must do it all myself. In the few hours I had spent at the Hawthorns I had successfully managed to surrender all my skills in self-management.

INTERMEZZO Back in the safety of the boarding house I just wanted to put my head under the pillow and sleep. Before I did this I scribbled the following work points down. Genuinely not as I expected. I had hoped to be able to sit anonymously. Be able to slip in and out quietly. Not like that at all. I found the whole experience harrowing. I now understand why the principal psuedopatient researchers saw fit to warn future participants in this type of methodology. Time is different. I was thrown into a completely different set of coordinates. Time contained a high viscosity: only a marginal relationship to TV time or staff rosters. The competence of staff against that of their clients marks out the principle difference. Staff so assured and confident. The woman who was pouring out tea was truly wonderful. Her indirect approach offered loopholes to any response I would wish to make. Patients. Notably, at the very start of my visit I recognised instantly the man on the drive as a “client.” At the end of my stay I am anything but certain that I can categorise patients in so narrow a definition. I now fully understand how my previous practitioners came to view patients “very differently.” I feel very humble towards my fellow patients. Recall with great shame the many times in the past that I failed to relate appropriately to them. So much more concerned with how I saw their condition. So much of my dialogue with staff seemed centred around choice. “Would you like a lift?” “Would you like coffee, tea, dinner?” The constant displays of options were outside the level of my competence. To each choice I responded with what I saw as involving the least demanding task to the enquirer. I very quickly lost my sense of adequacy and the ability to make rational decisions. I felt awkward and simpleminded in all the contributions I made to conversations.

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ADMISSION The days between my visit and the admission were marred by feelings of anxiety and depression. I had hoped to use this time productively and had brought a book with me. But this was not to be possible. The sheer turmoil of my inner dialogues suppressed all the concentration I possessed. I spent most of my time lying on my bed drifting in and out of fitful catnaps. I saw no reason to wash and I had no other clothes to change into anyway. With many misgivings I arrived at the clinic a little before eleven on Wednesday. I am determined that this time I will be more composed and more open to observation. Resolutely, I walk through the front door and I stand in the corridor by the doorway to the lounge. There are the sounds of a group of professional voices coming from the kitchen. I walk into the lounge and stand by my old chair. From the group of people a nurse calls out my name in greeting. And there, in the briefest span of time, I am again returned to my desolate state. I sit down in my chair. The group from the kitchen, caught up in there own dialogue, slowly amble towards the corridor and pass through the space before me. Two of the men are wearing expensive shoes and trousers. I guess they are visitors of a high professional stature. There is more conversation in the corridor before the two visitors leave. As soon as they have gone the nurse who greeted me comes up to me and introduces herself. I stood up. “Would you like a tea or a coffee?” asks Rachel. I can’t or won’t respond. It is not easy at all. Rachel says she is going to “the office” to tell “them” I have arrived. Despite my earlier resolutions I am ashamed that my courage has fallen so rapidly and I find myself slipping back into the dubious comforts of my arc. The settee has been moved slightly to the left but I can still pick up the reins that shape this structure for me. Rachel returns and in her loud cheerful voice invites me to come and see my room. I follow her around some comers and up some stairs. She is very fast and I have to scurry to keep up. Upstairs I am shown into a room not unlike those to be found at the more economical end of the business hotel market. It is certainly in better condition than the one I had left this morning. The room contains a bed, a wardrobe, a sink and a chest of drawers. Over

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in the comer, half facing out to the window is an armchair with wooden arms. Rachel has a yellow form. There are a number of questions to be asked. She asks me do I want to be addressed as ‘Pete’ or ‘Peter‘?’ I can only mumble to this young woman’s questions. She drops a sheet, a duvet cover and a pillowcase onto the bed. “Do you need any help to make up the bed?” “No, no, it’s all right.” It is a great relief to be given a task and left alone in this room. Even so, making the bed takes me some time. I do so want to make the bed correctly. When the bed is made I put my carrier bag3 on the bedside table and go and sit in the chair by the window. It is good to be in this chair. I cannot, or do not want to, take stock of the room. I have more than adequate space in my chair. Before she left Rachel gave me the Hawthorn’s brochure which is written in the form of a letter from an ex-resident. Dutifully, I read it but can only take in the comment that, at first, the new resident may feel ‘alone and afraid’. I try hard to understand the brochure but my powers of concentration are gone. Instead, I sit very still and my attention is given over entirely to a dead spider in the comer of the windowsill. It could have been half an hour but I am suddenly startled by the sound of someone knocking on my door. I am not really certain if it is my door, or, if it is, then what I should do. But my name is being called and I hurry towards the door. Another young nurse. She has black shoes and thick black stockings. Her manner is kindly and patient. I am to go with her, to the ‘office’, to be seen by the doctor. As I follow her into the office I am immediately entered into another world. In contrast to the functional tidiness of the clinic the office seems to be a magical space of administrative chaos. There are three or four over-crowded desks and a swivel chair has several files balanced on its seat. Notices, tacked one upon the other, clutter the sides of filing cabinets. There is a sense of a bustling busyness and, oddly, I am aware of the colours brown and maroon.

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Language For Those Who Have Nothing The doctor at the desk is very caring. He oozes understanding and if I concentrate everything I have upon him I can achieve some lasting eye contact. He begins by saying that ‘for legal and administrative reasons’ he must complete a form and would I mind being given a medical examination (‘No, no, its all right’). This is the stage I had anticipated as being the most fraught with difficulties. Here, surely, my deception would be the most difficult to sustain. But I needed few anxieties about my mask. The viability of my mask was already secondary to the abject meekness and desolation that I genuinely felt. My transformation into a dishevelled itinerant seemed complete. I probably didn’t much care what was happening to me. In between the probes and the blood pressures the doctor is conducting a standard Present-State Examination. All the time he is jotting down comments on my mood and awareness. He is very pleasant though and does not push me when I stumble. Rachel comes into the office and sits down and begins flicking through the pages of a magazine called PRIMA. I am not really aware of the two nurses in the office. I can only concentrate on the doctor and it is difficult for me to be drawn into a wider debate when the nurse with black stockings asks: “Do you want me to go and make you a cup of coffee or tea?” “No, no, no,” I say. The idea is shocking. That someone should be put to that degree of trouble on my behalf is unthinkable. I was surprised to find I could not remember the doctor’s name a couple of minutes after being introduced. He wrote his name down on a piece of paper but I still could not recall it a few seconds later. I apologise feeling that I have offended him. I make an equal mess of the date but to my credit I know which city I am in. He observed that some people who are depressed often think of finishing their lives and he wanted to know did I ever feel like that. I replied I had once, but not now, not any more. It is fairly easy to re-engage with the feelings I had when my marriage had broken down six years previously. To his questions of how I felt about not seeing my children I had no reason to deceive. He asked what went on in my head in the hours I spent alone. I try to explain to him about the space behind the settee in the lounge:

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‘If I stay very still, if I don’t move my eyes, I can make everything stop’. He begins to ask about voices and wonders if there is anything or anyone trying to harm me. I say that the landlord at the boarding house is trying to get rid of me. Two of his questions shift me into a brief but insightful reverie. He wants to know what music I like and what books have I enjoyed. I respond negatively – ‘nothing really’ – but in doing so I realise how easily I could have been tempted into a selfaggrandising repartee. Here in the office I occupy only the space that one sees. I have severed all my identity-forming connections. But instead of expressing these thoughts I pondered to myself how much the word ‘I’ is an otherwise prominent part of my vocabulary and of how much I depend on pretentious ties to otherness in order to maintain my identity. The doctor says he is not the kind of physician given to wildly prescribing drugs but would I like to take a sleeping pill for tonight, He goes on to say that he will see me on Friday and in the meantime would I consider taking a course of tablets. He offers to go and get the tablets from the hospital but I do not want him to be put to any trouble. I keep repeating that I am all right and that I do sleep well. But had he told me to open my mouth and swallow four enormous horse-tablets I am certain I would have complied without protest. The examination is over and the nurse with the thick stockings escorts me out of the office and up to my room. I feel I have exhausted all my energy upon the doctor and I am having considerable trouble in finding fresh energy to engage with her conversation. Outside my bedroom she tells me that over the next two or three days ‘the care team’ will come and introduce themselves to me. She tells me that if I need anything at all, or if I just want to talk to somebody, then all I have to do is ‘just knock on the office door’. I am also aware that she stands slightly away from me and I presume this is because of my stale smell. “There is a bathroom down there,” she says. “If you want to you can have a bath anytime you wish’. In my room I go to my chair and pull my jacket over my head. I make the choice to cry like a child.

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Language For Those Who Have Nothing My chair becomes my shell. I am frightened to move out of it. I am afraid even to look around the room. My attention alternates between the spider and the traffic on the road outside. The very idea that I could walk out of my room and down to the office seems outrageous. I recall from my army days a Brigadier who proudly announced that his door was always open to any chap at any time. Of course, 'any chap' with any sense would not even contemplate going near the building he was housed in let alone seek a private audience. My mind was wander through many life experiences. In my pocket I had an old wristwatch and I know that I sat in that chair from 1.30 until 6pm. This was a great swathe of solitude and occupied myself in listening in to many of my inner dialogues. From some of these, the intellectual and the interpersonal, I profited. But it seemed that the longer I remained alone the more frequently the content became unstable. Themes would appear and spin out endlessly only to repeat themselves again in a slight variation. Suddenly, at 6pm, there is a heart-stopping knock on my door. And then I am downstairs in the midst of many people sitting down to their evening meal. People are very kind. On my plate before me is a piece of casseroled chicken. I am offered a dish of potatoes and I take one. The lady whose leg has been raised puts another on my plate. But although I have eaten nothing since breakfast I have no appetite at all. The company of teatime chatter is overwhelming. I am very worried that if I am asked a question my mouth will be full of food and I won't be able to answer. Halfway through my second potato I put my fork down, and, in lieu of running out into the street, I walk into the kitchen and start washing up. It is such a relief to be at the sink and I occupy myself by cleaning some pans. I don't seem to notice that the cuffs on my jacket are wet with chicken grease and soapsuds. After a time the man from the drive and a woman in a flowered dress join me at the sink. I draw great comfort from the way we wash and dry the plates for to carry out this chore requires us to come into contact with each other. An arm brushes against mine and a hand is briefly laid on my shoulder. As we finish the man on the drive asks me how I am settling in and I reply I am very frightened. I notice that his face his podgy with a small moustache and he peers through big bottle-bottom spectacles.

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He says that when he came here he too was frightened but advises me that ‘it will be OK when I get better’. When all the plates are put away I am at a loss. In the lounge some people are settling down to watch TV and I silently slip away to my room. In my chair I begin to worry how I should get into bed. I feel very tired but I am concerned about taking my clothes off. A little after 9pm I kick my trainers off and crawl under the duvet. But it seems that as soon as I do this there is a knock at the door and head is bending round looking at me. “Hello. My name is Sarah and I’m the night nurse. I’m sorry if I have disturbed you. If you want a drink or something to eat in the night then just come down.” I feel embarrassed and I murmur something about being all right. Nurses have voices that are very loud and clear. I drift into long dialogues about the different ways I could have responded to her. I sleep until 3.30 but I awake wanting a piss. I realise don’t know how to achieve this. Slowly I sit up on the edge of my bed and put my trainers on. I am very consciousness that as I stand up the floorboards creak. Very carefully I creep out of the door and across to the toilet. The decision to flush the toilet is complicated by not wishing to wake the hostel and at the same time not wanting to be considered ill of by leaving the bowl discoloured by my concentrated urine. I am greatly alarmed by the noise of flushing pipes and I hurriedly tiptoe back to my room fearful that I be discovered. When I am certain no one has come to inquire over the noise I make my bed and go and sit in my chair. It is almost 4am and I am to remain here, undisturbed, until lpm. Nine hours is an extraordinary length of time to remain conscious and immobile in a chair. The knowledge that the care team might knock at my door permeated the anxiety of every minute. But as well as psychological reactions there are also real physical consequences to this practice. Among the more usual aches and strains curious tics and tiny spasms seemed to conjure themselves up from nowhere. My lips became very dry. But I felt that if I walked across to the sink to sip some water then I would attract attention to myself.

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Language For Those Who Have Nothing Often I drift off into reminiscence. Particular life experiences are hauled up and replayed over and over again. I recalled another incident from my ill-spent military career where I had gone AWOL to live with a woman on the East Coast of Malaysia. Eventually a combined force of local and (extremely irritated) military police retrieved me. Over the next few days I was subjected to a series of unnecessarily spiteful interrogations and the confinement to a prison cell. Certainly I had not reacted indifferently to these events but in no sense did the experience echo my present collapse of self-management. I began to play time-games with my watch. Deliberately, I refused to look at my watch in an attempt to judge the passage of an hour. To my great disappointment I found that what I had realistically considered to be an hour was in fact, in real time, only 25 minutes. The longer the chair time went on the more perverse my inner dialogues became. I found myself constructing scenarios whereby everyone was involved in a complicated plot to enhance my deception. I managed to twist the most trivial of remarks around and feed them into this conviction. Chair-time, I discovered, had a cloying and sticky quality to it. I seemed incapable of brushing away from my body the unending tensions that corroded the more positive dialogues I might become engaged in. At times I read, and re-read, the brochure that Rachel had left with me yesterday. Much of it was couched in expressions of ‘choice’ and ‘rights’: the right to be called by the name of my choice; the right to read my notes; the right to be treated as an individual and the right to privacy. No one, it said, will enter your room without knocking. I wondered what all these rights and choices meant. To whom do they belong? As I read them they seemed utterly alien to my own self-perception of being bovine and miserably inadequate. Around lpm the senior nurse I had met on Monday knocks and enters my room. The contrast from solitude to conversation is a strained one. She comments on the outside traffic and she tells me it is the policy of the Hawthorns to leave people alone for the first few days. She asks me would I like to come down and have

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a cup of tea. I follow her downstairs. The tea in the beaker is delicious and I savour each sip and realise how thirsty I am. Rachel is sitting in the lounge. The structure of the clinic suggests that Care Assistants occupy the spaces of the lounge and the kitchen while qualified staff fill-in the office space. I wash my cup and by staying close to the wall I manage to slip back to my room and the sanctuary of my chair. I spend four more hours here. My life has fallen into a pattern of enormous sweeps of time interrupted by the kindliness of strangers. These sudden contrasts in time are awkward and unseemly. Another knock at my door invites me down to the evening meal. I can only manage a couple of spoonfuls of soup. A woman has made herself a salad and begins to eat it next to me. This is a complex dilemma for me. For as long as I can remember I have carried an allergy to the smell of freshly cut cucumber. The smell of it is enough to take away my appetite and make me feel shaky. Even at my assertive best I can run into problems explaining this to sceptical restaurant staff. Here, I was in no position to explain the complexities of my discomfort. At the sink again it is wonderful to wash up and be in the close proximity of people. It is heartening to know that the man from the drive is unconcerned by my stubble and smelly clothes. Both he and the woman – I had unknowingly intruded upon their washing-up roster – were happy for me to help. As we finish the man invites me to accompany him on a walk on the drive. The fresh air is striking as if I’ve discovered it anew. We strike up a conversation that is innocent and naïve. He advises me again that things will ‘be all right when I get better’. He tells me he has a flat nearby but he cannot always cope. As we get closer to the traffic I feel afraid and I tell him this. We walk back into the kitchen where the floor is being mopped. As if by accident, I suddenly catch a glimpse of myself in a mirror. Is that really me? I look absolutely haggard and utterly filthy. The unexpected encounter with my image unsettled all the confidence I had gained from the walk. I looked around and discovered that I have lost my companion. I am so easily defeated. More chairtime. More dialogues. I resolve to myself that I will become more assertive just as soon as 8pm arrives. But come the appointed hour it takes me a further hour to gather enough

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Language For Those Who Have Nothing strength to go out of my room, go to the toilet and sneak downstairs. In the kitchen I meet again the senior nurse. She is friendly and says she has had a very busy day in which she has hardly stopped working. I am struck by the sheer disjuncture between her time and mine. The gap is colossal and of the highest magnitude. She tells me that it is not good not to eat. As she goes to her car I make myself a glorious pot of tea. Sarah, the night nurse, says hello again. Her voice is loud and each word is pronounced with great clarity. I feel she keeps a cautious distance from me and I realise what effect my appearance must have on strangers. I worry in case she thinks I might be violent and I am desperate to avoid this impression. “We have some Radox and shampoo in the office,” she says. “We keep it there for those admissions who arrive without them.” At first I am not able to hear her or take in the information properly. “I don’t understand. What are you telling me to do?” Even as I say it my response does not appear to make any sense. Sarah simply repeats the same statement but in a slightly louder and slower voice. Before I could answer her she walks away. At first I thought she was going to instruct the other night nurse (a Mr Johnson) to organise a bath for me. But no, the two night staff stay in the office and nothing happens. So I sit down in the lounge and as I do so I become aware of the other residents sitting there. Rachel’s PRIMA magazine had been left on the coffee table. The television is showing a film of two people shouting at each other. A woman is trying to complete a crossword and asks no one in particular for the right words. I know exactly the words she is searching for but I need more help to enter into conversation. The woman with the raised leg is slowly navigating a passage across the lounge and I try, with my eyes, to thank her for the extra potato she had put on my plate yesterday. Sitting there I become desperately close to the few people around me. I am overwhelmed by shame in recalling how I had previously related to people with mental illnesses. Here, I understood the depth of their identities and of how bloody difficult it can be to make your way in a rational world.

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It seems that unless I knock on the office door I am not to have a bath. I go back to my room and into chair-time again. For a couple of hours I watch the flickering of car lights. Eventually, I take off my clothes and wrap the duvet around me. I sleep fitfully. My dreams are desolate and destructive. It is probably safer to remain awake and engage with my intense inner dialogues rather than try to go back to sleep. With much guilt I suddenly realise that I have hardly thought of my partner at home. I know there is a pay phone in the hallway downstairs. But how would I use it? And what would I sound like? And what could I possibly say that would not cause her immediate concern? By five in the morning I am feeling too dejected to remain in bed. Carefully, I get up and dress myself as if in slow motion. I am again worried about attracting attention to myself. This time I use the sink to pass some concentrated urine. This shameful act spared me no noise. As I turned on the tap the plumbing suddenly gurgled with such an outcry that I feared I would awake everybody. I go to my chair and watch the traffic begin to thicken. The hours go by. Time is heavy and arid. I remember that Victor Serge once described his time in prison as akin to slowly crawling Westward on an Easterly-bound ship. In these long hours my inner dialogues seemed to pick up more speed and began to draw upon more intense emotions. Commonplace episodes from my past and the present became infused with guilt, or anger, or in the infliction of pain onto others. I imagined what it would be like pacing up and down the room but the noise from the floorboards discounted any experiments. My shirt had begun to stick to my back and the consequence of neglecting my hygiene had caused an irritating itch to flare up between two of my toes. The knowledge that I was going to walk out of here at one o’clock seems oddly unexciting. The attraction of a bath and a shave, some food, and a stiff whiskey or two, is remote and alien. The gravity of my position in the chair is burdensome. I am a dullard, time-travelling through treacle.. . . . . .. Suddenly, I am aware I am rocking in my chair. My head and my shoulders are moving backwards and forwards as if pivoted from my waist. To my alarm I realise I have been doing this for some minutes. I am afraid at a different and deeper level and it is

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Language For Those Who Have Nothing at this point that I make the decision to bring my project to an end. My watch says it is a quarter to eleven. I stand up and lean against the wall. I walk over to the sink and I am aghast at my reflection in the mirror. I look utterly filthy. My lips are encrusted and my tongue is scaly and dry. So I lean forward and using the palm of my hand I drink from the cold water tap. I find the pencil in my carrier bag and using the margins of the brochure I begin to write down, in tiny script, the events of the previous few days. At first this is hard to do but I understand that only from such discipline will I reconstruct myself. At one o’clock I walk down to the lounge clutching my carrier bag. Rachel is reading a magazine and looks up at me: “You going then?” She says that the doctor and the nurse are in the kitchen but I say I don’t want to bother them. For me it is over. But Rachel goes to tell them and they both come out and catch me on the drive. I can only thank them both and continue walking down the drive. This time I am extremely careful on the road. Even though the writing up of these events signalled my return to the familiar world there were consequences that I couldn’t lightly cast aside. The first one hit me three hours later as I was driving home up the motorway. I had pulled into a service station and found myself gulping down two bottles of water. At least it stopped the shaking in my arms. Intermittent periods of melancholy and feelings of shame often soured the next few days. After I had written these notes I found I didn’t want to talk to anyone about the experience.

DISCUSSION The two languages frankly and intensely peered into each other’s faces, and each became more aware of itself, of its potentialities and limitations, in the light of the other. M.M. Bakhtin4

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The foregoing events were written up within three or four days following my discharge. It carries all the strengths and is subject to all the flaws of every subjective account. I make no apologies for this. I am neither proud nor ashamed of what I did. If the experience left me with a deep insight into mental illness then it was an insight gained at the price of a lasting aftershock. For many days afterwards my body was burdened by a dull ache and for some months I hid the transcripts away and I was reluctant to even venture near them. My return to the familiar world declared itself by an over emphasis on my body and its standing. First, I threw away my old clothes and spent a lot of time in the bath. I had my hair cut and I took great care in shaving myself. For days I seemed intent on replenishing an unending thirst. I had clearly been dehydrated by my low fluid intake and it seemed that for a week my life was measurable in large mugs of tea. I also confess to the great comfort gained from standing shoulder deep with drinking men where I engaged in old tavern dialogues of bravado that either shrugged or laughed at the world. The effect the transformation had on my body partly explains the earlier warnings given by Rosenhan and Redlich to would-be researchers in this field. Chronotopes, (they might have said) are, after all, thick with flesh and, blood. Movements between the major ones cannot always be achieved without pain or social censure. Any attempt to enter a major chronotope from another puts the body at risk. In my case the impact of discarding the legacy of my social identity came as a sudden ideological jolt. By deliberately denouncing the concrete components of my more usual utterances I violated boundaries that are otherwise scrupulously respected by the wider neo-classical body. My transformation tested to the extreme the self-sufficiency of this parent body, for I had found, in these low fragmented regions, the connective material that makes an upright standing possible. There is no dialogue here. Only eyes that stare silently at each other.

TIMESPACE It comes as no surprise that my voice collapsed into the background noise of the Material Bodily Sphere. Having lost its familiar co-ordinates it had little choice but to fall, and fall rapidly, into the flesh and the matter of a quite different timespace. In Author and Hero in Aesthetic Activity Bakhtin argued that the formation of the self developed from three interactive markers. There is the I-for-myself (how I appear to me, to my own consciousness), the I-for-others (how I appear to others), and the other-forme (how others appear to me). These co-ordinates remind us that for

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Bakhtin the self is always a social product and is fully dependent on a relationship to others. It follows that those who wilfully distort the balance of this triad risk some immediate social consequences. At base we are all social beings and we care, and care very much, about the way others see us. Throughout my stay I was entangled in an alarming struggle between the modes of I-for-myself and I-for-others. The struggle had positioned me on the threshold of two systems of embodied time. Because these systems never coincided with one another it made it all the more difficult to determine from where the differing times were originating. I rarely found markers that were sufficient enough for me to establish some form of social standing. In my I-for-others mode I believe I was successful in taking on the voice of a tramp. I was no longer someone imitating a sad sack shuffling along the street. The mask was alive and I embodied all the conditions attendant upon the enfleshed consequences of the transformation. But if my uninviting I-for-otherness worked in a slowed-down time my inner dialogues moved at a formidable pace. In the orbit of my extended chair-time every stray thought was being sucked into a turbulent centre. New material was constantly dragged into an ongoing dialogue by a gravitational pull that erupted in short bursts of acceleration. The pace of these inner dialogues meant my thinking was in a state of constant transition. As one voice died another began. And just as soon as the new voice gained enough strength another voice was pulled in to degrade the integrity of its predecessor. And so it went on, hour after hour, around and around. These dialogues are the rightful property of grotesque realism’s cartwheel and in this sense they serve a positive function. As hard as it seems, every point of renewal was an opportunity filled with all the potentials of a fresh dialogue with another. All cyclical time is equipped with the ability to bend time. When I first entered the lounge in the Hawthorns I was raw and vulnerable and fairly frightened. It seemed to me obvious that I should manoveur myself towards anything that seemed secure. The arc I fashioned behind the settee was an attempt to resolve the humiliating conflict between I-for-myself and I-forothers. So unfixed had my position become in a relationship to otherness I found I was searching desperately for a point of resolution if not escape. Respite seemed possible only by withdrawing into a closed, I-for-myself, shroud. Once I was there I concentrated all my attention within this range of perception and I was able to sever the anxiety of myself as I appeared to others. There are positive potentials available in this timespace. In the spiralling movements of cyclical time I was granted the power to bend patterns in the carpet. I was also able to confirm from my intense relationship with the dead spider on the windowsill that some perceptions are revealed only through the settings of an outer stillness and inner activity.

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The senior nurse who complained of being tired after a busy day (she was already an hour late going off duty) is representative of the gulf between official and unofficial time. Those, like her, who occupy the Care Chronotope, are imprisoned by their continual references to the clock and the calendar. Every event becomes evaluated in the terms of linear duration. Even the doctor who examined me was putting my biography into some sort of chronological order. Yet, in the time I was living through, my concern was more with cycles than with lines. What, I wanted to ask the nurse, does this word late mean anyway and to whom does it belong? The same contrasts of time were represented in the space of the office. Its sheer sense of busyness and disorder marked off a difference from the cleanliness of the clinic itself. The pile of documents and the tacked-up notices on the wall was a display of an unconcerned capability in the midst of disorder. The shadow of the Ringmaster had walked through this office. Here was space that demanded the same acknowledgement of an imperturbable competence. A space that was filled-in by busy bodies who shared in the Ringmaster’s qualities of performing in the very arena of madness. Here, behind the office door was the confirmation that official time could never catch up with administrative detail. With its clock and complicated calendars the office was the hub by which everything else must be measured. To the care assistants the office was the domain of they or them in the office. To me it was space beyond the beyond. But I knew who and what lived in the office. Confined to my chair-time each minute was soaked in the anxiety of the arrival of the (dreaded) care team.

LANGUAGE The failure of two timespaces to coincide with each other was also reflected in the relationship between my voice and the official voice. What was being spoken and what was being heard were two entirely separate noises. The unsavoury nature of my profile, assisted by my unworthy and bovine utterances, meant that I had great difficulty in comprehending the voices of others. It seemed that before I could respond to a voice on the linear plane of meaning it was first necessary to suspend my own circular dialogues. I couldn’t always do this quickly and it accounts for why people had to repeat themselves so often. Virtually every nursing voice directed towards me was refracted through the register of choice and entitlement. As a working genre – complete with claims of independence from other discourses – this way of visualising the world has rapidly become a dominant language in the Care Chronotope. The idea that society should be composed of sovereign individuals capable of

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making meaningful decisions is a philosophy that has found a home in the not-yet ideals of the Care Chronotope. Indeed, consent theory can be said to have permeated every level of the national health agenda. Patients everywhere are now seen as free individuals to whom staged options are offered in the expectation that their consent will be given voluntarily. But, in making choices, it is not always the case that the patient is aware of the controlling attempts behind the options on offer. More often, the energies of clinical interaction are taken up in responding to a set of choices and the burden is placed firmly on the patient to refuse an offer. My own dialogues at the Hawthorns brought home to me how much of nurse-patient interaction is in fact a rehearsal of what a community should be like. The continuous enactment of individual-centred choice and entitlement is another part of the attempt to accelerate social evolution towards some future point of social development. As I have said, it is a philosophy that fits perfectly with the forward-facing direction of the Care Chronotope. Again, this is not to argue that consent theory is somehow wrong. It is more that the polyphonic traveller is required to be sceptical of any language that claims to be self-sufficient. On our travels we have seen that consent theory is identified with the preferred run of things and every voice that does not depend on this becomes marginalised and made irrelevant. Bakhtin gives many warnings on the dangers of ‘alibis-for-living’ overstepping their proper boundaries and being taken for real in the context of lived events. The problems of carrying theory into practice are revealed just as soon as the rhetorical foundations of a given alibi begin to creak and strain. After all, any real endorsement of patient choice must at some stage clash with institutional needs or in the calculation of acceptable risk. There are other weaker voices that are submerged beneath powerful concepts such as autonomy and advocacy and they must strive to find another way of breathing. The point I am leading to – and here I keep in mind Lucius’s fertile mixture of voices each with its own way to truth – is that every exclusive language inhibits the range of dialogue available and in doing so makes its own voice brittle and superficial. We are returned to that world where things are seen and not seen and where official and unofficial voices struggle silently with each other. Somewhere, I am sure, there is a law that states the higher a language posits itself the more it leaves itself open to the carnivalised forces of parody and subversion. All of the points I make are supported in an extract from an enquiry report into the troubled Ashworth hospital near Liverpool. Removing this restriction [regular bedtimes and getting up times] has produced a previously unknown freedom for the patients to choose when they go to bed. For many patients, the choice has been to turn night into day – to stay up all night and sleep during the day. One consequence of

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this has been the inability or unwillingness of some patients to participate in programmed treatment activities held during the day, and this is, ultimately, to their detriment. It might be felt that the nursing staff have a duty of care to ensure that the choices involved in staying up late are not allowed to compromise treatment programmes. [...] This is viewed by some staff as not only being in conflict with the principles of patient choice, but also laying staff open to complaints from patients.5 The space my body occupied at the Hawthorns was a disappointment to the belief that choice arises within a sovereign individual. In the end all meaning is to be negotiated between individuals and in the context of a unique timespace. My own circumstances meant I had no voice sufficient enough to make choices or to claim entitlements. My rights were not the same thing as my needs. For me to have exercised the right for a cup of tea, or to choose to take a bath, meant, in effect, that I had to surrender the sanctuary of my genre and seek space in the colonised region that was offered to me. Throughout my stay at the Hawthorns I was living at the lowest point of my strength and the notion that I had the choice to leave my chair and walk down the stairs and along the corridor to knock on the office door seemed an outrageous option to consider. I simply was not equipped to undertake such an anxiety-ridden mission. My way of seeing the world here was much in accord with the psuedopatients and the practitioner patients who had found it equally impossible to engage with rational options of choice. It should not be forgotten, of course, that the concept of corridor and office were not always constants in my spiralling dialogues. Properly conducted, consent theory works by the same face-to-face encounter a trader uses to strikes a bargain with a customer. It is to the practised skill of the vendor to manipulate the choice of a consumer to a desired outcome and it is to the skill of the customer to survive the bargaining process profitably. As a consumer I had little to offer any vendor and for me the matter of choice was always the line of least resistance. An option which I used to lessen the intensity of the fragile bridge between Ifor-myself and I-for-the-other. The market place prefers customers who do not shuffle around with downcast eyes. There were no face-to-face encounters with nursing staff. I saw them more as half-bodies and I knew them by their trousers, their shoes, or their thick black stockings. Quite the most heartening aspects of communication were those I experienced by indirect methods. The woman who included me in a conversation without addressing me directly made a real connection with my abject state. Like the great circling dialogues of parody her voice offered me a simultaneous entry and an exit loop. Her voice placed me on the threshold of a dialogue I was never to come across again. In a slightly different way I got great comfort from the indirect physical contacts I gained in washing up with my fellow

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patients. These people seemed indifferent to my wretched state and their proximity to me was in direct contrast to the distance I perceived in the nurses.

FOUND FELLOWSHIP Within this framework, the error of ‘psychological ’ social psychologies becomes clear. Simply, they seek to explain We-experiences in a framework which implies that they are I-experiences. Liam Greenslade6 Like Lucius, the nature of my more usual utterances had been so corrupted that an environment I should have been familiar with was suddenly seen as something entirely new. Here I began to read the activities of others against a new surplus of seeing. Not only did these new sight lines have the effect of changing every object of my encounter but they also changed me as well. In my own and Lucius’s transformation both our bodies were enfleshed by a chronotope that was always on the threshold of anticipated crises and unexpected events. What was particularly alarming for me was that I had to take the full complement of my body with me into the clinic. This was something I had not done before. I realised that previously I had been merely content to rely on my status or my intuition to justify my presence in the workplace. Something different was happening here. And when it happened it happened quickly and painfully. My body took on a sense of permeability, by which I mean it began to breathe in time to the rhythms of another voice altogether. My journey confirmed, for me, the Bakhtin School’s conviction that a standing of a body is in direct proportion to the strength and social organisation of a collective voice.7 No matter what degree of fragmentation is imposed on one body by another every voice will seek to validate itself as a creature of social fellowship. Whatever the hardships endured a voice will find a dialogue that offers it a shelter and the means of establishing a relationship. ‘No voice,’ Bakhtin reassures us, ‘is ever lost [...] every meaning will have its homecoming festival.’8 Although I have spent many years working professionally in wards and day centres I never once saw patienthood in the revelatory manner that I came to see it in my guise as a patient. To compound my insight further I had always considered myself as innovative in my work. Some of my work in the past had been radical enough to cause my managers alarm and I had often abandoned the institutional wisdom that smoothes the steps of every

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professional career. As a manager of a social services hostel I had been fervent in implementing a regime that had choice and rights as its leading themes. Uncomfortably, I recognised my self in the overworked body of the Hawthorn’s senior nurse. I, too, had spent far more hours at work than my contract demanded and I, too, was never far from meetings, messages and the never ending updates of procedures. I consider the key insight I gained was not in the differences between staff and their patients, though this was significant enough, but in the recognition of the differences between those who are mad. My transformation had allowed me to stumble into the cohesiveness that holds this difference together. I recall first catching sight of the man on the drive where I was able to assess, immediately and intuitively, his probable psychiatric status. If pressed, I could hazard an accurate diagnosis and even go on to suggest his likely course of medication. I was hardly into my stay at the Hawthorns before I shamefully realised how this form of evaluation is irrelevant and even puerile. Even though my subsequent meetings with this man were never to rise above the level of naïve innocence – he spoke only of getting better or it will be all right in a bit – I learned to relinquish my intuitive ability to set his irrationality against my own competence. In this most humble of timespaces I had found a fellowship that enabled me to enter a dialogue that made both of us visible to each other. Here I was suddenly a participant in a relationship that required no referrals to definition. Bakhtin always claimed that Dosteovsky never permitted his characters to take on second hand definitions and many of his heroes actively fought against the surplus of themselves being uttered in some other’s voice: They all acutely sense their own inner unfinalizability, their capacity to outgrow, as it were, from within and render untrue any externalizing and finalizing definition of them. As long as a person is alive he lives by the fact that he is not yet finalized, that he has not yet uttered his ultimate word.9 When Bakhtin proposes that untruths are discovered ‘within’ he is referring to the ‘within’ of the we-experience and not from some individual standing. Such truths, and their discoveries, are closely allied to the uniqueness of being and every living individual is dependent upon a relationship to otherness. In fact, it is the very refusal to accept a surplus closure by another that gives a social organisation its inner strength. Nowhere is there such a thing as a voiceless stance. In the uniqueness of every context there is a voice that cries: ‘I am more than your analysis says I am; my words or images mean something other than what you say they mean.10

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I contend that there are many dialogues living in the Patient Chronotope. Many are considered trivial or untidy or are simply not heard. The perfonnative dimension of my journey suggests that only by physically stepping down from the privileged sites of a professional standing do these dialogues become available. There is much value to be gained, and again this is my claim, from putting one’s uniqueness at risk and making the decision to gamble with some unfamiliar chronotopes. For me, so powerful were the linguistic spaces that revealed themselves that I was made to realise how narrow the pathways actually are on this landscape. They are narrow because the ways of traversing the environment are closely monitored. They are narrow because there are equally restricted ways of encountering madness. And they are narrow because we are allowed so few ways of entering into a dialogue with madness. But I am perplexed and full of questions here at the lowest point of my step-down. And this is how it should be. Whose voice speaks for this fellowship? Whose voice owns mental illness? And who hears it? How much of the linear routines of busyness is a defence against opening dialogues with patients? And who is saying this and to whom? And what is the specific problem that the official language is the solution to?

FTC: p 122. Deleuze, G. and Guattari, F., Anti-Oedipus: Capitalism and Schizophrenia, London, Athlone Press, (1972) p2. 3 The carrier bag contained an old shirt, a two week-old newspaper, and a pencil. I took no notebook with me preferring to rely on writing up immediately after each stay. 4 RAHW: p465. 5 Moth, Z. and Williams, R., eds., With Care in Mind Secure: A review for the Special Hospitals Authority of the services provided by Ashworth Hospital, London, The NHS Health Advisory Service, (1995) p681. 6 Greenslade, L., ‘V.N. Voloshinov and Social Psychology: Towards a Semiotics of Social Practice’, in Psychology and Society: Radical Theory and Practice, Parker, 1. and Spews, R., eds., London, Pluto Press, ((1996) p123. 7 MPL: p88. 8 SG: p170. 9 PDP: p59. 10 Emerson, C., ‘Introduction: Dialogue on Every Corner, Bakhtin in Every Class’, in Bakhtin in Contexts: Across the Disciplines, ed. Mandelker, A., Evanston, Northwestern University Press, (1995) pp1-32. 1

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Chapter Ten

Consummation

But the truth that might oppose such falsity receives almost no direct intentional and verbal expression [...] it does not receive its own word – it reverberates only in the parodic and unmasking accents in which the lie is present. Truth is restored by reducing the lie to an absurdity, but truth itself does not seek words; she is afraid to entangle herself in the word, to soil herself in verbal pathos. M.M. Bakhtin1 My journey is ending. I have tried to think psychiatry through the borrowed words of Mikhail Bakhtin and then to step down from this level go and live among its everyday practices. His voice, on what should have been for me a familiar landscape, has provoked a number of unexpected encounters. Voices, previously considered to be obvious or silent or simply unheard, have been discovered and shown to be making their own formshaping contribution to the body of psychiatry. For me all these dialogues have had the effect of re-mapping this landscape. I see psychiatry now more as a four-dimensional terrain with each aspect of its body being fed by a capillary system of standings: chronotopes, heroes, forbidden words, Ringmasters, grotesque bodies, classical bodies, and so forth. By my means of camouflage I was able to place myself in a different system of timespace. Although the power of my mask projected a colourless and unremarkable demeanour – and thus permitting me to pass unnoticed – it also made me engage the whole of my body in this world. There was no retreat available to some objective secondary position and there was no secure vantage point in which to observe the events taking place around me. 211

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Put crudely, if you want to know what the landscape is like you have to go and live there. So it is here that I must deliver on my belief that polyphony contains sufficient potential to be offered to the practitioner. I present polyphony as a state of preparation, as an interlude in the general arrangement of things, and as a means of leaving a voice in order to return to it.

POLYPHONY Bakhtin’s great exposition of polyphony, the Problems of Dostoevsky’s Poetics, presents at first sight, a utopian and a counter-intuitive vision. In promoting Dostoevsky as the architect of the polyphonic novel, Bakhtin portrays a method that combines, with equal weight, the voice of the author and the voice of the character. The independent voices that make up Doestovsky’s novels not only engage other characters in open dialogue but are perfectly capable of challenging and surprising the author who created them. Unlike characters that populate the more monological novel polyphonic narrative is built from voices that are separate from the central authorial voice. As voices intent on furthering their own meaning they remain free to contribute to an always-unknown outcome. From this it can be seen that two principal forces are at work in polyphony: the first is in the plurality of independent voices and the second is in the creative contributory position of the author. Not surprisingly, such an unstable formulation has meant that the concept of polyphony has been used in a number of ways. And not the least by Bakhtin himself, who, typically, appears content to let the term wander loosely through his writings, taking on or discarding, according to its needs, different points of emphasis. Polyphony must struggle to find its own negotiated position in relation to everything else that makes up the body of Bakhtin’s work. Indeed it can be said that any text with claims to a dialogical status could hardly do otherwise than encourage other ideas to graze in its own pastures. This means, of course, that every Bakhtinian concept is definable only up to a point. Each one is tethered to a dialogical both/and axis rather than an either/or form of organisation. Things are to be built one with the other rather than being uncovered by stripping away its connective tissues. As well as being blessed with all the qualities of hecorning polyphony also possesses the unnerving capability of being able to speak back to its scrutiniser. But any identification with the optimism and buoyancy suggested by dialogical approaches can lead to difficulties. Bakhtinian scholarship – provoked by convention for closure and classification - often finds itself

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withdrawing into the limited position of declaring polyphony’s most stable properties. For example, Hirschkop2 uses the concept of polyphony to describe the separation of the author’s voice from their characters, and, drawing on polyphony’s literal meaning argues that it explains the social stratification of linguistic registers. Morson and Emerson3 claim that polyphony sets the position of the author in a ‘dialogic sense of truth.’ Polyphony, for them, is a truth nurturing the threshold site of voices in the novel. Clark and Holquist4 maintain that polyphony is interchangeable with the term ‘dialogism.’ Both concepts recognising the values of the ‘I’ and the values of the ‘other.’ Alternatively, Stam,5 in a compelling argument, puts a political gloss onto polyphony. For him, a polyphonic society is a multivoiced society, one where participatory voices are free to address the problems of inequalities and at the same time cultivate and celebrate cultural differences. Of course, none of these representations are wrong in any Bakhtinian sense. As commentators on Bakhtin they have chosen to position themselves alongside the idea of polyphony and have gone on to extend (Morson) or to enter into dialogue (Stam) with the concept. And this is as it should be. What would be wrong, however, would be to assign polyphony to an indifferent or anti-theoretical position. Bakhtin anticipates the same objection to polyphony – we can lose ourselves in ‘fields of vision’ that lead only to further ‘fields of vision’6 – by firmly rejecting any alliance with relativism. Ideas, like the utterances that express them, must have vigour and a passion to engage in a living dialogue. There seems little point in entering into a dialogue already weighed down by relativism. The saving grace of all things dialogic lies in its enfleshed sense of meaning. And polyphony, as a concept, is alive and breathing among the boundary lines that blur the differences between the true and the untrue, the useful and the futile, and the official from the unofficial. Its value is in the recognition that the murmurs of background voices are always contributing, albeit indirectly, to the unity of an official discourse. Thus, the convention that progress is to be gained only by a system of linear and graduated closures is strongly countered by polyphony’s assertion that we lose something in the way we distance ourselves from the discarded other. The more monological methods of enquiry, once its knowledge base becomes secure, will impatiently discard the voices it was formed from and politely forget them. Polyphony carries no such disrespect. It refuses to abandon the stratum of familiar contact and chooses to concentrate all its energy into the manner of approach in any relationship. It takes, as its working material, the uncertain anxiety that fuels the threshold of every encounter. And, as we have seen, the manner of the participant‘s approach will best determine the potentials of the encounter.

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Bakhtin holds that polyphony is itself in a transient stage of development. In Towards a Reworking of the Dostoevsky Book he uses the theosophical premise that a body will prepare itself, sometimes for centuries, for a favourable birthday.7 The epoch in which the idea is born into is occasionally wise enough to accept its import but more frequently the parent body will need to continue its development. Up to now the body of polyphony has found its most able carrier in the creative genius of Dostoevsky and its development continues. In great time, notes Bakhtin, ‘Shakespeare became Shakespeare’ and ‘Dostoevsky has not yet become Dostoevsky, he is still becoming him’.8 At present we have the gift of a nascent concept and we have few metaphors to work with it. For now polyphony encourages us, as authors, in the steeping-down or the steppingout from our more usual frames of reference. Our reward is in the brief glimpses given of something more and something beyond the context of the encounter; of a world built by a new compositional form. But we saw in characteristics of the Care Chronotope the dangers of investing everything onto some not-yet horizon. The faith in some future development cannot be taken as an evolutionary certainty. Bakhtin’s emphasis on the birth of polyphony serves two purposes. The first one is rhetorical. The promise of polyphony’s future demonstrates the degree to which our thinking is permanently entangled in the alibis of conventional explanation. We are so accustomed to seek authority outside of ourselves that we are too ready to surrender our own responsibility as participants in an encounter. Secondly, and more importantly, Bakhtin is doing more than assigning the promise of polyphony to some future age. The different I’s of the polyphonic approach and the different nows offered by a variety of chronotopes grant to us the perspective of different timespaces. Polyphony not only opens the potentials of encounters that can take place in odd places and at odd hours it also equips us to be prepared for them.

ICONS [I]cons are created for the sole purpose of offering access, through the gate of the visible, to the mystery of the invisible. Icons are painted to lead us into the inner room of prayer and bring us close to the heart of God. Icons are not easy to ‘see’. They do not immediately speak to our senses. They do not excite, ,fascinate, stir our emotions, or stimulate our imagination. At first, they seem somewhat rigid, lifeless, schematic and dull. They do not reveal themselves to us at first sight. It is only gradually. after a patient, prayerful presence that they start speaking to

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us. And as they speak, they speak more to our inner than to our outer senses.9 A deeper understanding of polyphony can be gathered through Bakhtin’s own eccentric dialogue with Orthodoxy. A substantial part of the nature of polyphonic encounter can be learned from considering the relationship that forms from one who stands before an icon. These sacred paintings have passed on their unchanging imagery over centuries (or in the terms of every Orthodox prayer age unto ages). The absence of an icon’s shadow and perspective is symbolic of another and unimaginable timespace. Their flattened images have already gazed into a heavenly timespace and they act for the earthbound as a window into the divine. Properly prepared – and the prayers of the Eastern Church are enriched by bodily acts and frequent contacts with the earth – the encounter with an icon means to place oneself on the threshold of two realms of timespace. The polyphonic point I am making is that such an encounter requires change on the part of the spectator. The relationship requires something more than to gaze into the dreamy eyes of the icon: a transferential gaze – one that merely transfers authority on to another - is not enough. I would suggest that polyphony guides us towards the idea that the outcome of prayer and of miracle is dependent upon the productivity of two consciousnesses rather than on the mercy of a single omnipresent power. Indeed the secret of all miracles may well be contained in the power between two interacting voices rather than in the power of one. The lame man cannot suddenly throw away his crutches without counting his own powers into the transformation. The leper, suddenly healed, must begin immediately to make sense of a new system of standing. We are not concerned with uncovering causes. If we remove the bad it does not necessarily mean that only the good will be left. For a body to create a changed approach to otherness means that it must be prepared to renounce the sanctuary of the more familiar certainties and strive towards the embodiment of a dialogical truth before another. It isn’t easy because it demands a different sense of personal responsibility. Bakhtin’s encoded theological references unsettle our comfortable relationship to God. For Bakhtin, God is seen as the ultimate polyphonic author. A God who grants to characters the free will to lead lives that are good or evil: ‘God can get along without man, but man cannot get along without Him.’10 Humanity is left with the knowledge that in the end it is mankind who must reveal its own voice and come to judge its own activities. And if we don’t do it for ourselves there is a God who will. William Wordsworth famously extolled that we all arrive in this world ‘trailing clouds of glory’, on loan, as it were, from God’s own home. This same world, says Bakhtin, is ‘given’ to us and is one where we are all required to live among the mysterious and unique events that unfold around us. God

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gives us a world and a life worth living for. After all, what else must we do with life except live it? Minute by minute, we have a real responsibility to effect the unique timespace we find ourselves engaged in. And as uniquely created individuals we have the free will to use this time positively or to use it negatively. A dialogical perspective on the future for the human condition rests on an ambition to co-exist in a world composed of events that follow their own chains of momentum, of events that take their own turns and regressions, and of a world that is not progressively working towards an underlying closure. In both great time and small time events occur in ways that cannot be anticipated and the ways of the world continue to demonstrate a stubborn refusal to fit into any ordered scheme of things.

WHAT RELEVANCE HAS POLYPHONY TO PSYCHIATRY? The direct answer to this question is that polyphony grounds psychiatry in a new topography. On this landscape polyphony’s starting point is in the audacious openness to see along unfocussed sight lines and to hear the chorus of background noises. In these impurities that impinge upon the official world are the voices that have been closed down and discarded in the relentless pursuit of the unitary word. In contrast polyphony welcomes chance development and is willing to engage its reality in dialogue. Bakhtin: [T]he author speaks not about a character, but with him. And it cannot be otherwise: only a dialogic and participatory orientation takes another person’s discourse seriously, and is capable of approaching it both as a separate position and as another point of view.11 The act of being by another heightens the potentials of becoming and is in itself a constructive activity that requires the traveller to contribute to the encounter. It is a fully enfleshed practice that is concerned with building a dialogue with others. We saw in all the psuedopatient dialogues how a region we had previously thought contained no obvious signs of life was sharply brought into focus. By altering the body of their utterances the psuedopatients were able to venture into an unvisited and desolate region. Voices that were otherwise excluded were brought in from the canteens and the car parks and placed alongside the ideologies of the treatment suites. Voices, heard and unheard; time, used and unused; spaces, filled and unfilled, were shown to make up the variousness of the landscape and served to remind me that other realities also shape this territory. For me, I came to realise that only in the combinations of these placements is it possible for blood to flow along its corridors and its timespace take on flesh.

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I cannot pretend that polyphony is not a challenge to the administrative and medical demands that are made upon the practitioner. The assessment of madness continues to refine diagnostic and treatment regimes against approved frames of reference. And the utterances of practitioners are refracted through permutations of standard formats. Accordingly, the reality of any dialogue is hampered by the practitioner’s sideward glances to the more elevated sites of meaning. I would wager that at this very moment practitioners of every rank are entering observations into files and folders. As official anecdotes these bundles of information serve different purposes. Not only are they used in clinical interviews but also they are needed for administrative purposes, to uphold one’s reputation among one’s peers, or to counter the possibility of some judicial scrutiny. Other voices have vested interests in the reality of clinical dialogue. Does this all mean that psychiatry has got it all wrong? Not at all. Psychiatry has been and continues to be a space that offers help to the confused and frightening. After all, drugs sometimes do work. There are many prescriptions that assist and enable a body to maintain a social standing. The same can be said for electrical treatment, for supportive psychotherapy, and even from the chance to be offered a bed and a few hearty meals. Where the Care Chronotope becomes resistant to new potentials is found in its blending of management and care. The linking of these terms, both heavily laden with unitary values, has led to a strict and limited approach to the messy task of looking after strangers. This approach stems in part from the way the Care Chronotope’s own disciplinary roles have arranged themselves in history. A dangerous mixture of historical forces and ever-present economic anxieties has caused the disciplinary bodies to become cramped into compartments. And the resultant tension is replete with all the human frailties and conflicts that make any system of management tick. In every disciplinary utterance traces of allegiance, debts, and past betrayals are to be detected. Zygmunt Bauman12 observed that the fate of many institutions have come to rest on a ‘floating responsibility’ whereby the sheer numbers of groups that now contribute to an overall task has meant that it is difficult to locate any answerable centre. Bauman’s picture would be admirable if the multiplicity of people he refers to spoke with different voices. The fact is, for the most part, that they don’t. Every professional voice bears some resemblance to systems of thinking that radiate from pulse points on the landscape. A good example of the doublevoiced nature of the professional voice can be seen if we look at the way Bauman’s ‘responsibility’ is patrolled and limited at the ancillary level of the modern clinic. Trained heating engineers are now required to bleed radiators, light bulbs must be replaced by qualified electricians, and a team of superannuated porters is needed to re-position the office desk. So

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ingrained has the compartmentalisation of voice and responsibility become that it is deemed unprofessional – the ultimate insult - to question such riskfree precision. Coinpartmentalism readily transfers its limitations onto the administratively tidy formats that are used to organise patients. Karl Jaspers’s legacy of the scientific standing of the practitioner has ensured that the embodiment of verstehen has largely hindered the potentials open to dialogue. He himself is aware of the tension between the opportunities for dialogue and institutional demands for closure: We have to submit to the patient’s individuality and allow them to give verbal expression to it. On the other hand we have to investigate the situation from a number of definite points of view with certain guiding aims in mind. If we neglect the latter we get a chaos of detail. If we neglect the former we simply pigeonhole the particulars in to a few rigid categories which we already have; we see nothing fresh and are likely to do violence to our material.13 There are two voices in Jaspers’s statement and one is a commentary on the other. In this double voiced utterance the adept practitioner knows intuitively which voice is articulating the approved direction. On this landscape there are limits to intuitive privilege and the balance of considerations. Such abstract positions are capably patrolled by the pull of various standings. The Care Chronotope demands a distinction between those efforts that compel things into an order, as against say, any enterprise that would seek to acknowledge the self-organisation of a living landscape. Any venture with polyphonic travel has the immediate side effect of relativising the psychiatric landscape. The traveller gains a critical distance on a terrain that is organised into hierarchies of authority and prestige. The changed position granted to the traveller gives an enhanced sensitivity to ways bodies connect and disconnect themselves to voices that emit particular ideologies. And it is not long before the traveller comes to learn how unwelcome trespassers are warded off or neutralised. This is a landscape cultivated by the amplification and defence of its most elevated sites. And where one stands in these shifting surroundings depends largely on what these visible systems of thought are expressing. But if we understand that this is the way things are on this landscape then the position of the traveller is far less threatening. If the traveller accepts that this previously familiar landscape is composed of many different nows and I’s then the opportunities for travel are greatly enhanced. In polyphony the traveller sees truths spread out on a ‘single plane’14 which means that encounters with different voices are formative to all relationships. This is not to say that the traveller must lose the fear of truth and the effect it has on

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their body. The more able the traveller becomes in refracting truths through different mediums the more able they become in conducting themselves rationally and responsibly. Polyphony issues the traveller with a sense of lightness, an eye to the carnivalisation of encounters, and a comfortableness with confusion. More and more I feel the polyphonic traveller should wander unnoticed along the corridors of the clinic, wearing ordinary clothes, gently opening the swinging fire doors, and queuing quietly for cheap cups of tea. The question of polyphony’s relevance takes us again to the brink of the political dimension. In an age still coming to grips with the joyous possibilities evolving from a ‘post-marxist pessimism’15 it is understandable that some commentators have sought to extract political agendas from Bakhtin’s work. Indeed, the idea of carnival, polyphony, official and unofficial domains, are concepts ripe for political transformation. I make the point again that political confrontation, in its broader either/or sense of meaning, was never part of Bakhtin’s remit. If anything Boris Groy’s16 perspective of Bakhtin working as part of an interdependent dualism within the official regime is the more productive insight. David Shepherd17 holds that there is no ‘system’ to be transposed from Bakhtin. Bakhtin works, grotesque fashion, ‘from the inside out’ in ways in which understanding becomes a response to the sudden juxtapositions of probabilities. Therefore, to return to the original question, the relevance of polyphony to psychiatry lies in ways the traveller has approached its territory from the inside and from below. From these angles of approach the traveller encounters relationships with a unique form of outsideness. We are simply travellers on a terrain. There is no brief for reform or revolution. We may well come to know that this world is foolish but we must abide with some of its foolishness. In this context polyphony is to be understood as a means of preparation to re-enter the official landscape.

WHAT POTENTIAL IS LOANED TO THE PRACTITIONER BY POLYPHONY? The concerns of this question can be addressed by reference to Bakhtin’s own biography. Bakhtin’s potentials are often as elusive as he is himself. This quite extraordinary character managed to remain, as it were, almost invisible to attentions of the Soviet regime. We know that physically he was a near-permanent invalid with a life long lung disorder complicated by his stubborn addiction to tobacco. Recurrent and painful bouts of oesteomyelitis led to the amputation of his left leg. Weeks at a time were spent bed-ridden. Were it possible to translocate Bakhtin to our own time we would see a

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figure, I am sure, more as a candidate for social services than the secret police. Surviving photographs suggest a surprised and harmless modesty as if the camera had captured the frightened eyes of some creature peering into the forest clearing. To the very end of his life he lived with a material and social modesty and expressed little ambition for any enhanced professional standing. His life was lived in a quiet and humble refusal to accept the fictions with which official systems of thought cannot help but be replete with. He could not, or would not, use the telephone, he rarely replied to letters, and seemed content to assign his completed manuscripts to the storage of a damp woodshed. An often-cited anecdote has an impoverished Bakhtin using the pages of his essay on Goethe to roll the tobacco of his cigarettes. In day-to-day conversation Bakhtin was ‘aloof and superficially accommodating’ and to the many visitors he received towards the end of his life he was polite but ‘gave the impression that he agreed with their ideas. When asked direct questions about his own beliefs, he was evasive or silent.’18 The splendid modesty of Bakhtin’s voice needed something more than his own singular determination. The body of his living ideas needed to be transcribed onto the dead material of the printed page – and hence into great time - by the facilitation of two separate groups of people. Both groups of people were characterised by the intensity of commitment and the degree to which they disregarded the political consequences of their actions. The first group, loosely the Bakhtin School (1918-29) – was composed of flamboyant characters driven by starvation from the big electrical cities. These penniless intellectuals submerged themselves in marathon sessions of dialogue: ‘magnificent philosophical nights of strong tea and talk until morning.’19 I suggest that only by entering into the ‘we-experience’ of this fellowship was the I of Bakhtin the author able to generate his early works. The second group (1961-75) was responsible for rescuing Bakhtin from some thirty years of exile. Although Bakhtin’s early Doestoevsky book had never been officially discredited, it had lain in some ideological mid-zone, where to make reference to it was considered unwise. In 1961, a group of young Moscow graduates, led by the obsessive energy of Vadim Kozhinov, were surprised to discover the ailing scholar was still alive and ekeing out an existence in Saransk. For my purposes it is sufficient to note that it was only through the use of cunning and ruse that the Kozhinov group, in quite daring negotiations with the Moscow publishing houses, ensured Bakhtin entered into great time. Clark and Holquist’s excellent biography of Bakhtin documents much of the guile that was necessary to confront the constraints of the Soviet regime. The argument I want to put forward from these two periods of Bakhtin’s life can be built in a number of ways. Firstly, we can deliver Bakhtin from

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his cudak reputation. There is no gain, or indeed any loss, in portraying him as a romantic individual wandering on the edges of social registers. The ‘intense strangeness’20 so often attributed to Bakhtin’s character serves only to force the example of a uniqueness of voice in relationship to otherness. Secondly, it was only by moving alongside the magnitude of a collective consciousness and entering into the orbit of a discovered fellowship, that Bakhtin’s voice was able to gain in meaning. There are loose parallels to drawn here with the isolated voices of the mad who used the cycles of parody to test-out particular truths. Volosinov’s formula, forged in fellowship of the Bakhtin School applies: ‘the more powerful and the more differentiated the collective in which the individual enters into, the more animated and the more vivid an individual consciousness becomes.’21 Thirdly, there is value in examining Bakhtin’s ‘extraordinary ability at communicating with people from all walks of life and educational levels.’22 An ability, I suggest, that derives from his own well-guarded sense of creative outsideness and his unflagging belief in the interconnecting nature of the world. For him, the world is ever Janus-faced, two voices always face away from each other and are ultimately incapable of a mutual understanding. In one direction lies the unitary demand of ‘theoreticism’ and to the other, ‘the never-repeatable uniqueness of actually lived and experienced life.’23 It is everyone’s fate to come upon this world in the ‘performed act or deed of seeing, of thinking, of practical doing.’ Life that faces in the direction of the lived event is not something thought of. It is something that simply is; something accomplished in a relationship to otherness. Life that is lived here can only be ‘participatively experienced or lived through.’ Bakhtin casts the tensions between these two faces with the element of choice that lives at the starting point of all responsibility. It is I, after all, who occupies this once-occurrent timespace and that ‘which can be done by me can never be done by anyone else.’24 Both the road and the act of wandering are recurrent metaphors throughout Bakhtin’s writing, and, for the traveller, he provides several systems of navigation. To wander on the road is to enter into a particular type of time-flow and to commit oneself to a specific narrative drive: ‘Each genre is only able to control certain definite aspects of reality.’25 As can be expected any journey on the road leaves the traveller open to unexpected dangers (and unexpected rewards) of chance encounters. Only occasionally will these methods of travel take us through exotic landscapes. As we saw earlier, Lucius’s adventures were tracked entirely through familiar territory. To travel on this road is to discover the extent to which the ordinary and the everyday have been made familiar. Indeed, so familiar are these chronotopes that they have no beginnings and no ends. Bakhtin notes that when Don Quixote set out on his famous adventures the road he chose had

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already been made familiar by countless travellers before him. In fact, the road the Don rode along was already ‘profoundly, intensely etched by the flow of historical time, by the traces and signs of time’s passage.’26 But because, by definition, the body of the traveller must be fully engaged, the immediacy of the road becomes a completely realised timespace. No longer able to depend on the intuitive cursors of encounter the traveller must now face the familiar as something unusual. So for the traveller the potentials yielded to polyphony issue from a position outside the orbits of unitary languages. The flow of the road and the necessary adjustments to different voices converge within the criteria of polyphony. As with the psuedopatients, whose radically altered positions dramatically changed the feel of their relationships to others, the traveller is also permitted a temporary respite from the forces that shape the more familiar ways of encountering another. On the road they discover that bodies, like narratives, are entangled with the imagery provided by the stories of everyday timespace. And from our own visits within the Care Chronotope we know that bodies need to continually nourish themselves with explanatory parables. In the fearlessness of the Ringmaster’s anecdotes we were confronted and challenged by a voice that ‘demands we acknowledge it, that we must make it our own.’27 The final triumph of one voice over another marks the most prominent features of a landscape formed by the repetition of a limited number of core narratives. Polyphony’s task begins from the very point that the traveller decides to escape from these artificial selfhoods. For me, the point in which I knew how much my own body depended on the familiar was realised in my encounter with the man on the drive. A career spent in official spaces had long made the curiosities of institutional driveways obvious and even banal. The driveway to the Hawthorns was much like many others I had travelled upon. Everything should have been obvious. Everything should have moved as if it could not move in any other way. And as I walked towards the clinic the figure of a man ambled into my field of vision. In the space of a second, my well-practised intuition had enframed him as a patient. His dated clothing, the shuffling gait, the drowsy countenance, and the background of the kitchen annex were all forcibly pulled into my surplus of seeing. This surplus was more than sufficient for me to author an identity onto the man. The same surplus was also enough to limit, and deafen in advance, the potentials of any encounter before it could even be realised. But my own transformation had severely shaken the bland perceptual alertness that generally sustains my confidence in the face of uncertainty. Where, previously, I had been both a product and a producer of the Care Chronotope ideologies, I was now in an encounter where these values seemed to count for little. The very simplicity of this meeting

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demonstrated the effort I required to ‘sign off’28 from all the ‘alibis’ that think themselves through me. What was evident to me was the power of competing voices to hold me in a fully realised timespace. For the briefest of time I was locked into a primary position of ambivalent confusion. One voice was already laden with anxiety, another reminded me of an allegiance to propriety and restraint, and yet another was driven by curiosity. Here, on the road, I discovered that polyphonic approaches always contain something dialogically essential. The encounter reveals something about itself but it also discloses, and changes further, the position of the author. My stay at the Hawthorns became an environment rich in epiphanies. Every single surplus of vision was glimpsed on the threshold of a new discovery. The impact on me was profound if not painful. Because I had managed to escape from a unitary fashioned selfhood I was able to realise the living limitations of languages that force its members to act according to a set of customs. In the narrow and earnest seriousness of consent theory I encountered a language that sees life as a series of entitlements, a language addressed to a one-sided interpretation of consumer need. Offered a series of choices – to ask or not to ask for a bath, to choose to leave or to stay in my room – I was invited to respond by giving the same answer to the same question. In this almost nagging form of discourse the answers and the questions are stitched together in the same voice. The answers are already structured before the question is spoken and neither the question nor my answer seemed relevant to the immediacy of my experience. Questions in the Care Chronotope generally concern themselves with process rather than with questions of substance. Practitioners are permitted to ask only how a procedure is being steered or developed along a linear line of development. Only the mad would ask if the policy has any value at all. My journey as a psuedopatient corresponded with Lucius’s chronotope. In both of our adventures, as time unhinged itself from its more usual sequences, the imagery of others was seen in a fragmented and scattered fashion. A world that is seen through the eye-holes of a mask becomes filled with sharply segmented frames and is governed by a time that moves by ‘crisis and rebirth.’29 Bakhtin cannot help but allude to the influences of the Orthodox tradition in Lucius’s chronotope. He makes reference to the ascetic practices of the early church fathers who sought a spiritual purification by withdrawing into the wilderness to live a life closely connected to the earth. Lucius followed the same pathway. A young and active sinner who was transformed into an ass and lived at the lowest echelons of life before his purified rebirth returned him to the ordered world. For Lucius the time spent at this level left a ‘deep and irradicable mark on the man himself as well as on his entire life.’30 We know that the Orthodox Saint, Seraphim of Sarov, had a strong spiritual influence on Bakhtin.31 No

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doubt he got great comfort from Seraphim’s extended periods of silence and material deprivation but perhaps Bakhtin recognised in the saint a kindred spirit who remained within the tradition of Orthodoxy yet gently declined to accept the privileges of the organised church. For sixteen years Seraphim chose to live alone in the Russian forest before he returned to his community. He died in 1833 and there are transcripts of encounters where people speak of a spiritual irradiation that seemed to physically glow from his body. I make no claim that I came to possess the same forbearance and piety of Seraphim. But I will confirm that my journey left the same irradicable mark on me as it did upon Lucius. I am now more comfortable alongside the mad than I ever was. There are no longer any therapeutic or political ideologies that get in the way with my speech. I am happy to merely sit or walk alongside the mad. The lessons of polyphony have taught me that I need more than a professional or an intellectual approach to madness. The avoidable discomforts I endured as a psuedopatient acted as a reminder to me of how painful is the responsibility to actually sign-offfrom all my alibisfor-living. Yet there is another side to this responsibility. If the starting point for polyphony is to sign-off from the high to enter the low then it must at some stage sign itselfback into the ordered world. Polyphony as a means of travel is to be understood as a temporary step down in order that a beginning can be taken up again. The journey is a daunting one and the traveller must call upon differing standards of bodily imagination and be moved to make cunning adjustments to familiar utterances. In the same way that the early fathers spent periods of time in the wilderness and in the same way Lucius descended into the depths and the depravities of common life, so too must the polyphonic traveller be prepared to take similar risk with their own uniqueness. In the examples of the psuedopatients we saw a group of people willing to commit themselves to take seriously those human experiences that lie outside the remit of unitary analysis. Revealed in their narratives is a different standard of imagination and a different variant of selfhood. Working out a method for polyphony requires the discovery of places at some distance from the orbital pull of dominant markers on the landscape. But once discovered another method is required in order to return And return we must. Because polyphony is so to the ordered world. buffeted by unexpected encounters it must be accepted as a preparation for return. Whether the traveller chooses to scavenge through the rubble of jokes or to step down into the silences of a back ward, their journey must always be seen as the leaving of one voice in order to return to it anew. In carnival terms the ‘aim is to find a position permitting a look at the other side of established values, so that new bearings could be taken.’32 Polyphony is at a relatively early stage of development and, for now, the

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most we can ask of it are in the glimpses bestowed upon us by a fleeting separation from the pressures that shape the neo-classical body. And the traveller must find these treasurable glimpses alone. It takes effort and it is an individual mission achieved by deed rather than by argumentation. And so I end my journey. Along the way I have visited some quite desolate places. Because of my unfixed standing I have always worked alongside appearing or becoming forms. I certainly attracted some strange companions. I stumbled upon a wide array of truths that ranged from everyday barbarity to the heart breaking simplicity of a patient’s voice. Alongside others I too laughed as the Ringmaster dismantled and reassembled bodies into manageable forms. I too contributed to the smoothness of the neo-classical body by mocking fragmented bodies with clever terminology. Occasionally I came upon an official truth that proved itself to be ‘maliciously inadequate to reality.’33 I came to recognise this voice by the chill sense of closure it left me with. Here was a truth at odds with the truth I found in those quiet silent places that are arrived at only by stages of crisis and rebirth. I was able to spread out all these, and other truths, before me on the roadside. In the body of Christ Bakhtin saw an inwardly facing spiritual severity that was coupled to an outward expression of love:

For the first time there appeared an infinitely deepened I- for-mysel f – not a cold I-for-myself, but one of boundless kindness toward the other: an I-for-myself that renders full justice to the other.34 And in Bakhtin’s dialogical words lies the key to polyphony’s relevance. The very best practitioners are those who simply practice kindness towards the other. The resolution of distress, if that is what is being sought, is to be won only when two voices struggle together to build to a dialogue.

DiN: p309. Hirschop, K., ‘A response to the Forum on Mikhail Bakhtin’, in Bakhtin: Essays and Dialogues on His Work, ed. Morson, C.S., Chicago, University of Chicago Press, (1 986) p11. 3 Morson G.S. and Emerson, C., Mikhail Bakhtin: Creation of a Prosaics, Stanford, Stanford University Press, (1990) p236. 4 Clark, K, and Holquist, M, Mikhail Bakhtin, Cambridge, MA., Harvard University Press, (1984) p242. 5 Stam, R., Subversive Pleasures: Bakhtin, Cultural Criticism and Film, Baltimore, Johns Hopkins University Press, (1989). 6 PDP: p49. 7 TRBD: p299. 8 ibid: p291. 9 Nouwen, H.J.M.,cited in Markides, K.C., Riding With The Lion: In Search of Mystical Christianity, London, Arkana, (1996) p276. 1

2

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TRDB: p285. PDP: pp63-4. 12 Bauman, Z., Postmodern Ethics, Oxford, Blackwell, (1993) p18. 13 Jaspers, K., General Psychopathology, Manchester, Manchester University Press, (1963) 10 11

p38.

PDP: p29. 15 The phrase belongs to Terry Eagleton in Walter Benjamin: Towards a Revolutionary Criticism, London, Verso, (1 981) p149. 16 Groy, B., ‘Nietzsche’s influence on the non-official culture of the 1930’s’ in Nietzsche and Soviet Culture; Ally and Adversary, ed. Rosenthal, B.G., Cambridge, Cambridge University Press, (1994) pp367-90. 17 Shepherd, D., ‘Bakhtin and the reader’ in Bakhtin and Cultural Theory, ed. Hirschop, K. and Shepherd, D., Manchester, Manchester University Press, (1989) p105. 18 Clark. K. and Holquist, M., pp2-3. 19 ibid: p55. 20 Holquist, M., ‘Introduction’ to DiN, (1981) p xvi. 21 MPL: p88. 22 Clark, K. and Holquist, M., p50. 23 TPA: p2. 24 ibid: p40. 25 FM: p131. 26 FTC: p244. 27 DiN: p342. 28 TPA: p38. 29 FTC: p115. 30 ibid: p 116. 31 Clark, M. and Holquist, M., p133. 32 RAHW: p272. 33 DiN: p309. 34 AH: p56. 14

APPENDIX ONE

STUDENT CLUSTER 01Q These are quite realistic anxieties [on exams]. (1)

02Q By the time of qualification you have to do two years as a House Officer. Sorry. One year. (2) 03Q Before you all decide not to come on Wednesday.. .. [it was hinted that Wednesday’s session might include “embarrassing” questions]. (2) 04Q All this is in the handout. (1) 05Q Vivas. Anyone not anxious about them? Either lying or something wrong with them. (2)

06J Hallucinations happen to everyone at night. Might happen to medical students during the day. (1)

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07Q You must all be feeling shell shocked. (2) 08Q Get like you lot. Tired. Anaemic. (1) 09Q Last year’s group said it [a considerably more demanding appraisal] should be introduced. (4) 010Q Students get up at 6.30. Wash. Shave. That is if you are a guy.. .. (1) 011Q I am aware that medical students are not as involved in the student drug scene. Consequences of drug-taking are more than if you are studying English. (2) 012Q Don’t write it down. Unless you really want to. (1) 013Q Why do some people always ask awkward questions? (1) 014Q You wouldn’t jump in and ask “Are you impotent?” (1) 015Q At this rate you might become a joint doctor. Come on. A person on the street can tell me this. (1) 016Q Anxiety. Let’s look at exams. You can decide to avoid studying (1). . . stay up late at night (1). , . drinking caffeine.. . . (1) 017Q . . . . hope the course is not too taxing? (1) 018J Student asked why don’t ants get depressed? Answered that they get more sex with more ants. (3)

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019Q I’ve had to choose short names to fit on one line of my laptop. (1) 020Q Were you all here yesterday to discuss [subject]. Do you want to tell me about it? (1) 021Q I don’t expect you to write all this stuff down word for word. (1) 022Q There are people who drop out of medicine and lead very exciting lives. (1) 023Q There is a handout. So you don’t have to scribble this down. (1) 024Q I’m surprised that 15 of you are here. I feel very privileged. (1) 025J If I brought a lion in here you’d all jump out of the window. If I told you it was tame, with no fangs and no claws, you might stay but go and report me. (3) 026Q Don’t write it all down. (1) 027Q Is this Monday morning or are you all embarrassed? I was going to put you in the hot-seat. (1) 028Q Don’t write anything down. I want you to think. There are handouts to be given out. (1) 029Q If you get this one you get a Crackerjack pencil. (1) 030Q When you become GP’s give me a hint in your letters. I can’t be a detective all the time. (1)

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031Q You are all dead-on targets [age group]. Anyone of you want to be one of our specimens? (1) 032Q You can read this in DSM IV. You can see it’s quite a heavy book. (1) 033Q Why is important to qualify? 034Q Don’t ask are the Martians coming? (2) 035Q You won’t be left alone. [interviewing patients] Don’t worry. (3) 036Q Very brave of you [a late student] to come in like this. Hardly worth coming. (2) 037J Could be sitting totally paralysed. Can’t speak. On my viva I just talked too much . . . . Or you could answer to “What is schizophrenia?” .. . er .. er ... er ... (3) 038Q Obs and Gyney? Ah. Easy. (2) 039J Stand in front of the mirror and look at yourself closely. You don’t enjoy what you see. Those that do come back and I will treat you. (2) 040J This is the best group I’ve had. I’m lying. (2) 041Q You will meet some insensitive psychiatrists. They will make you squirm. (2)

042J Do not say: “I will put radioactive rods in your brain.” (2)

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043Q Don’t write it all down. (1) 044Q Just smile and say you are doing psychiatry. It really unnerves them. (2) 045Q Groups of girls. All wearing luminous socks. (2) 046Q Some of you will be gannets [on eating habits]. (2) 047Q It’s not just have a cup of coffee, have a chat and say “there, there.” (2) 048Q Families do affect children. Most of you will see me as a father – least until you get to know me. (2) 049Q Don’t scream at me if it isn’t happening. (1) 050Q You are very quiet, very tired as a year. We’ll do supportive therapy on you. (3)

051Q Don’t allow someone who is suicidal to sit near an open window. (2) 052Q My ego is strong. I am firm but fair. Someone said I was known as the hatchet man. (2)

PATIENT CLUSTER 053Q . . . . wearing a lot of lipstick, not in line . . .. (1)

054J A flasher referred. Expected him to be old and in a coat. But no, he was a bodybuilder. Huge. I could not ask him .. . . (1)

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055Q This is why they tell you to drill here and here [points to skull] and stick a ballpoint pen in. (2) 056J Flooding? You can put them in a room with a few spiders crawling about. (2) 057J “Have you thought of killing your neighbour?” “Yes. I’ve got some guns hidden away.” (2) 058J I’ll tell you an interesting story. It’s true. Homosexual man exposed to images of dressing man and undressing woman. Doctor met homosexual six months later. “Thank you doctor. I get excited by dressed men now.”

(2) 059J . . . you get [on a video] a whole load of people having epileptic fits on it. It’s fantastic. (3) 060Q Lots of bodies under the floorboards. This, in fact, was a delusion. (1)

061J 64-year-old-man. Lived on his own in a sparse flat. All his life worked aloft in a crane. Took his breaks and meal aloft. No friends. Psychiatrist called in by the police. Patient convinced CIA had Araldited “bugs” in his ears. (1) Brain waves are beamed in and out. Picked on by CIA. Forced him to masturbate. “How do you know?” “Because I never use my left hand.” (4) You can imagine the policemen and the Social Workers laughing. I asked him later was he possibly lonely? “Lonely? What with all this lot going on.” (3) 062Q . . .. born in 1995 . .. oops

.. .1985. Yes he was born. (1)

063J . . . not a punishment [ECT]. We don’t say to patients: “Right. ECT.” And zap them with it. (3) They are not dragged down by six nurses. (3) Not usually. (1) Need to dispel these myths. (1)

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064Q I’m not stupid. I don’t want to die. [on taking sensible precautions when interviewing patients]. (1) 065J 16 stone nurse called Tiny watching a patient in a cell. Stupidly, I leaned over to look at him and the patient made a grab at me. Tiny had me flattened against the wall . . . (3) 066Q . . . when six burly policemen throw you into a cell with a psychotic . . , . (2) 067J Patient, a professional golfer, used to hit people with golf clubs when he became manic. (3) A very aggressive, huge man. Demanded sleeping pills from me. Refused. Came back next morning. Stormed into surgery. I thought “uh oh” this is the end. (2) But he hugged me. Sobbed and sobbed. “Doctor. I think I’m ill.” (3) 068Q RAMPTON! [answer to a question on what one should say to a patient confessing to child sexual abuse. Rampton is a well-known high security mental hospital]. (4) 069J He said she was hitting him. She said she was having an affair. I didn’t know what was happening. (1) 070J Two or three sessions of ECT. That usually livens them up. (4) 071Q Can’t get into a psychotic’s head. There’s no point. I just can’t get in. [on empathy]. (2) 072Q Very much a sexist remark by a consultant. “She’s just a dizzy blonde.” And she was. (1) 073J Not uncommon to have more than one Jesus Christ on the same ward. (2)

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074J Woman came into my office and said, “OK. You can tell me now.” “Tell you what?’’ “You can tell me that you have fallen in love with me.” (4) 075J Woman. History of abuse. Lives in a flat. On the game. Burgled. Decides to commit suicide. Naked. By the bath. Suddenly sees reflection in the mirror. It is the Devil tempting her. Puts on fur coat. Throws razors into toilet. Walks out. It is woman returned as Christ. (2) 076J Patient sees flickering light outside. Sits back and smiles. “Do you want to share this with me?’’ (1) Patient explains that a conspiracy of doctors and administrators are linked to 157% of the criminal population. (3)

077Q Psychogeriatric nurses often wear several pairs of gloves. Not surprising when you smell the place. (1) 078J [continues 075J above] . . . she goes out on the street, collects six blokes from Skid Row who believe she is Christ and takes them to her brother’s house. Brother gets her put away and the police move the disciples on. (415) 079Q .. . . nicking underwear, wearing it

... . (1)

080J Woman washing lettuce leaves three times. Outer, inner, breaks it up. Washes it again. (2) Asked why, she said so the pesticides won’t poison her husband. In fact she hates her husband. Could not stand semen inside her — especially her husbands. (3) 081Q Parents were at a pro-life conference in London when their son attempted suicide. (1) 082J Patient had a friend described as built like a fork-lift truck with manners to match. (1)

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COMPETING THEORIES 083J Psychoanalysis. Where you lie on a couch .. . usually done by a German. (2)

084J Men’s groups. Sit around and talk about how precious they are. (1) 085Q I’m a psychiatrist. So I’m a pervert. (3) 086Q GRIMSBY! A perpetuating factor . . . . [ on biological and environmental causes of depression. Also an unpopular allocation]. (3)

087J Ask someone what they would do if they found a letter with a stamp on it. They are supposed to say “I’d post it.” (1)

088J Nothing will convince this duck that I didn’t lay this egg [on bonding]. (2)

089J Psychology tests on students. Filled in personality tests. All given same category. 80% thought the results accurate . . . . No better than astrology. Leo? Pices? (2) 090Q You have to realise that psychiatry is organised in a different way. (2) 091J Conservative Party. How they have not been picked up by psychiatrists I don’t know. Applies to other Parties as well. (1) 092Q I’ll briefly show you Freud in two minutes ( 1 ) . . . I don’t believe any of this. (2) 093Q I can’t make you sexually attracted to camels. I can never do that. (3)

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MISCELLANEOUS 094J Clocks! Whoa! Yeah! [hypothetical fetish objects] (3) 095J Please sir, I’ve reached puberty. (3) 096J Some people who are slightly manic seem to bubble on all day. Do very well. Get the best jobs. (1) 097Q Coffee? Let’s not tell her she’s in the wrong room. [refers to arriving tea lady]. (3)

098J As a kid I pushed a six-year-old into the path of a girl. “He loves you.” (2) 099Q Good examples of modelling are chat-lines. They are learned. (2) 0100J The wicked witch had long beautiful hair and a lovely gown. The beautiful princess had a hooked nose . .... (2) 0101J Child said the horse should trample all over father. Which I thought was great to express anger in this way. (1)

0 102Q Promiscuity? Sex

. . . I think that means. (3)

0103J The USA. That bastion of individual freedom, asks you to tick a box to say you are not a terrorist, have not got HIV, or have been mentally ill. (1) 0104Q You will find the police take murder very seriously

APPENDIX TWO

UNOFFICIAL TERMINOLOGY COLLECTED FROM THE INTRODUCTORY LECTURES TO PSYCHIATRY GIVEN TO MEDICAL STUDENTS Liven them up, feeling very fragile, shrink, totally wild, not quite there, quite mad, very mad (x3), wild and aggressive, bubble on all day, oddball, oddball children, unbalanced, not actually functioning, going to collapse, crawling up the wall, off their heads, go very very crazy, crazy (x2), full blown illusions, suddenly pops into your head, bonkers, brain rot, best end/worst end, off his head (x3), high as a kite, out to lunch, selective brain rot, go beserk (x2), over the top, go through the roof, fall apart, shadow of former self, bizarre (x5), weird, cheesed off, cracked, mollycoddle, zap (x4), quite uppity, loopy, drive me spare, cagey, tanked-up, creeps up, struggling end of the spectrum, very scary, knocked out, spill the beans, down to earth, flicking very quickly, go up (x3), he’s going to go up, a dropout, whizz (x5), lost it all, brings them out of it, flicking, wheedle her on, settle down, light-hearted, stressed out, switching off, keep him up, dabbled, fall to bits, not right in herself, breaks down, hang together, stays intact, all fragmented, total loss of self, collect themselves, frenzy, odd, fall to pieces, flip in and out, calm them down (x”), going off in a big way, a bit nowty, out of control, so out of it, sort them out, speech was a load of rubbish, crippled, switch off, worked like magic, grew more and more ridiculous, can cripple you, jerks them out of it.

237

INDEX

Active double voiced discourse, 50 Addressee, 87 Addressivity, 34, 38, 44, 50, 87, 88, 91, 145, 164 Agelasts, 51 Agnostico, 14 Air, 81 Alibis-for-living, 1 10, 1 14, 1 17, 181, 206, 223, 224 Alongside, 16, 49, 97, 109, 118, 120, 159, 181 Ambivalence, 59, 65, 75, 86, 102, 105, 150, 173, 175 Anecdote, 48,49-51 Anti-psychiatry, 11 8, 145 Apeleius, 143 Ashworth Hospital, 206 Assad, M.L., 18n. 95n. Authority, 62, 65, 67 Bakhtin School, The, 33-34, 43, 208 220, 221 Barton, R., 175-6 Bateson, G., 78 Bauman, Z., 2 17 Beauchamp, T.L., 177n. Belle indifference, 27 Belmont Hospital, 1 19 Bergson, H., 58 Berrios, G.E., 85 Bethlem Hospital, 64, 65 Bohr, R.H., 177n. Both/and, 17 Branthwaite, A., 30 Brody, F.B., 178n.

Brooke,D.,77 Bulmer, M., 146

Carnival, 4, 6, 17, 66, 76, 93, 99, 100,138,154,171 Canetti, E., 28-29 Care and terror, 74, 77-80 Carstairs, G.M., 12 Cartwheel, 90, 101, 102, 117, 125, 128, 132, 134, 139, 153, 158, 162, 173, 204 Case history, 50, 67 Caudill, W., 146, 151, 152, 160-72 Chamberlain, J., 159 Childress, J.F., 177n. Chronotope, 10, 16, 21-31, 98, 1 16, 119, 143, 144,201 chronotope, care, 14, 23-6, 29, 49, 77, 91, 110, 134, 153, 169, 173, 175, 205, 218, 223 chronotope, castle, 25 chronotope, patient, 23, 27-8, 130, 131, 135, 152, 156, 167, 173, 175 chronotope, Rabelaisian, 57, 63 chronotope, threshold, 52, 56, 59 Clark, K., 18n. 31n. 213, 220 Clarke, B., 64 Clare, A., 18n. 95n. Clay, J., 121n. Clinical autonomy, 13 judgement, 13, 14, 15 responsibility, 24, 44 Circus, 63 Conmorbidity, 25

239

240 Continuous narcosis, 25 Contrasts, 63 Cowper, W., 65 Crammer, J.L., 46n. Crown, S., 177n. Cunning, 9, 48, 97, 144, 220, 224 DSM IV, 42, 81, 85 da Vinci, L., 74-5 Danow, D., 36, 97 Dean, C., 70n. Deane, W., 147, 148, 150, 151, 152, 156-7 Deception, 9, 48, 97, 134, 144 Deleuze, G., 208n. Dennett, A.S., 63 Descriptive phenomenology, 13, 6 1 de Swan, A., 112n. 155-6 Dialogism, 3-4, 6, 16, 36, 37, 44, 108, 138, 174, 212 Dialogue, 10, 11, 14, 17, 18, 29, 33, 36, 44, 50, 88, 91, 108, 132, 136, 150, 207, 210, 213 dialogue, inner, 27, 28, 124, 132, 168, 169,202 Dingwell, R., 146 Discovered fellowship, 124, 137-40 Doestoevsky, F., 48, 49, 111, 207, 212, 214 Don Quixote, 222 Double-bind, 78 Double-voiced, 2 17-8

Language For Those Who Have Nothing Fourth drama, 164, 166 Freidson, E., 76 Freud, S., 87, 98-9 Gatekeeper, 182-3, Gaze, 11, 13, 58, 61, 65, 67, 92, 159, 163,215 Gellers, G., 24 Genre, 9, 10, 33, 36, 82, 165 Gerber, D.A., 62 Gibson, D., 3 1n. Gilmore,H.R., 178n. Goffman, E., 145, 175 Golden Ass, The, 143 Goldman, A.R., 177n. Gordon, P., 15 Gramsci, A., 1 13 Greenslade, L., 208 Griffith, T., 79-80 Grinker, R.R., 46n. Grotesque, 62, 66, 69, 138, 150, 153, grotesque, hybrid, 10 1-2, 104 grotesque, realism, 8, 60, 61, 62,78, 137, 163, 167 Groy, B., 18n. 219 Guattari, F., 210n.

ECT, 66, 124, 131, 188 Eagleton, T., 226n. Einstein, A., 22 Either/or, 17, 212, 219 Elitism, 13 Ely Hospital, 79, 91, 103-4, 107 Emerson, C., 45n. 112n. 210n. 213 Entstehongsherd, 37, 38 Ethics, 48, 146-7 Explanation, 13, 51 Etymology, 81

Harrison, P.J., 10 Hammond, P., 100 Hay, G.G., 144-5 Health of the Nation, The, 40- 1 Helman, C., 100 Hero, 11, 14, 24,41, 42, 59, 62, 75, 78, 80, 86, 91, 93, 119, 159, 207 Heteroglossia, 6 Holquist, M., 18n. 31n. 36, 213, 220 Hogarth, W., 64 Historical inversion, 24 Hughes, S., 129, 130, 131, 133, 152 Humour, practitioner, 47, 48, 52, 53, 59, 60, 62, 78 Hutcheon, L., 166-7 Huxley, P., 41

Farberow,N.L., 150, 153, 155, 157, 167, 171-2, 173 Faulkener, A., 127 Field, F., 60 Fish, F., 12 Fleischman, P.R., 146 Fool, 81, 159 Forest, J., 21 Foudraine, J., 136 Foucault, M., 37-8, 64, 69, 175

ICD 10, 42 I-for-myself, 203, 207 I-for-others, 203, 207 Icons, 2 14-6 Ideology, 34, 43 Initiation, 56-60 Institutional neurosis, 175 Intonation, 6, 24, 34, 44, 54, 59, 92 Intuition, 13, 207, 218, 222 Invisibility, 77, 88, 103, 107, 134,

Index

241

153, 154-5, 156, 181, 219 Issacs, A.D., 143

Mueller, B., 147, 151, 154 Myers, E.D., 30

Jackson, C., 140n. Janet, P., 139 Jaspers, K., 10, 11, 12, 13, 14, 16, 40, 41, 61, 62, 68, 91-2, 139, 169, 218 Jenner, F.A., 18n. Jokes, 10, 87 jokes, as carnival, 55 jokes, classification, 52, jokes, targets Joki, I., 87 Jones, M., 121n. Jonsson, U., 178n. Journey partner, 1 14, 1 18 Jung, C., 149

Napier, R., 80 Nash, W., 47 Neaman, J., 81 Nelson, T.G.A., 54 Neo-classical body, 15, 62, 103, 147, 153-4, 155, 181, 225 Nietzsche, F., 6, 13, 37-8 Nightingale, F., 76 Nouwen, H.J.M., 226n.

Kaldun, I., 178n. Kavasilas, N., 5 Kozhinov, V., 220 Kraupl-Taylor, F., 12, 84 Laing, R.D., 78, 107, 113-20, 139 Langue, 33 Laughter, 10, 163 alliance, 55 collective force, 56 psychic release, 54 philosophy, 55 rapport, 54-5, scales, 52 Leff, J.P., 143 Legman, G., 53 Lewis, A,, 12 Lodge, D., 162 Lower bodily strata, 6 Lucius, 143, 147, 148, 173, 176, 184, 207, 221, 223 MacDonald, M., 64, 80, 179n. Maim, H., 120n. Markides, K.C., 226n. Masters, A., 71n. Material Bodily Sphere, 6-8, 9, 60, 76, 89, 99, 105, 165, 203 Mayer-Gross, W., 12, 84 Millon, T., 177n. Mockery, 9, 144, 167 Moneiro, A.C., 18n. Morgan, H.G., 24, 44 Morrall, P.A., 28 Morson, G.S., 45n. 87, 112n. 164, 213 Moth, Z., 210n. Mouth, 103-4

Obsessive-Compulsive States, 84-5 Official, 11, 27, 28, 38, 43, 47, 168, 203 Orthodoxy, 4-5, 21n. 35, 223 Osmond, H., 120n. O’Sullivan, D., 70n. Other-for-me, 203 Outsidedness, 108, 109 Palmer, J., 53, 87 Parody, 11, 28, 87, 181, 207 Parole, 34 Patterson, D., 45n. Pharis, M., 174 Pinel, P., 13, 69 Polyphonic traveller, 44, 48, 73, 76, 78, 85, 86, 92, 97, 103, 109, 113, 135, 138, 139, 145, 165, 170, 181, 218-9, 221-2 Polyphony, 10, 16-17, 42, 48-9, 51, 97, 103, 109, 120, 143, 144, 212-4 Posited space, 37 Possession, 83-5 Post, F., 39, 169 Pre-Frontal Lobotomy, 25 Present-State Examination, 193 Primary Position, 78, 104-5, 109, 115, 120, 147, 149, 173, 175, 223 Psychiatry, lay concept, 57 Psuedopatient, defined, 144-5 Rabelais, F., 7, 9, 89, 90, 100, 103,

104

Rabichow, H., 174 Rampton Hospital, 86, 91 Redlich, F., 146, 160-1, 179m. 203 Relativism, 17 Responsibility, 11 1, 1 17 Reynolds,D., 150, 153, 155, 157, 167,

171-2, 173

Ringmaster, 43, 60, 63-9, 73, 83-5, 86, 88, 91, 92, 99, 100, 108, 182,

205, 222 Rippere, V., 140n. Rockwell, D., 150-1, 152, 154, 156, 173 Romantic Primitivism, 119 Romanticism, 98-9, 163 Rosenhan, D.L., 145-6, 149, 155, 1589, 161, 168, 170,203 Ross, M., 84 Rubbernecking, 107 Rycroft, C., 112n. Ryklin, M., 85 Sacks, O., 123, 124 Sass, L., 163 Saussure, F., 33-4 Sayce, L., 127 Schneider, K., 12, 84 Scull, A., 24 Secondary Position, 98, 106, 108, 109,

120, 155, 173

Seraphim of Sarov, 224 Series, 75-7, 89 Serio-comic, 165 Seriousness, 11, 92 Serres, M., 7,94 Shakespeare, W., 80, 214 Shepherd, D., 219 Shepherd, M., 18n. Sherman, C., 147, 151, 154 Siegler, M., 120n. Slater, W., 84 Smail, D., 121n. Spevack, M., 94n. Spitzer, M., 12, 38-9,44 Stallybrass, P., 61 Stam, R., 6,213 Standing, 12-14, 22, 35, 38, 45, 48, 57, 60, 90, 100, 154, 155, 173, Steinberg, T.A., 177n. Steiner, G., 33, 107 Step-downs, 17,47, 98, 103, 120, 176, 177,208,224 Stratification, 9, 38 Surplus of seeing, 7, 60-2, 69, 93, 155, 208, 222-3 Surprise, 17, 103, 105 Symington, N., 121n. Szasz, T., 80

Temporal description, 24, 27, 28, 29 Thaler, O.F., 146 Therapeutic community, 25 Thinking vision, 13, 16, 58 Third, the, 85-8, 89,93 Time, adventure, 144 cyclical, 75, 76, 101,204 great, 82 horizontal, 74 imposed, 130 small, 82, 83 vertical, 75 Tuke, S., 13 Uncanny, The, 99 Understanding, 13 folk belief, 28, 135 Unexpected, 17, 103, 105 Unitary language, 9, 10, 12, 16, 28, 38-9, 51, 68, 91,92, 119, 125, 139, 146 Unofficial, 27, 28, 43, 134, 136, 144, 159, 165, 168,203 Ununderstandable, 14 Utterance, 9, 23, 24, 27, 29, 33, 34, 36, 48, 50, 145 Verstehen, 13, 14, 15, 218, Vlissides, D., 18n. Voice, 15, 16, 56, 85, 155, 157, 164, 204, 208, 209 Volosinov, V.N., 2, 33-4, 116,221, Ware, T, 35, 108 Watt, D., 46n. Weiner, B., 177n. Weitz, W., 148-9, 172, 173 White, A., 11, 38, 92 Whittingham Hospital, 88, 91 Wilber, K., 106 Willeford, W., 82 Williams, R., 140n. 210n. Winkler, R., 151-2 Words, 9, 34, 35-6, 43, 60 words, naming, 88 words, sleeping, 80-2 Wordsworth, W, 2 15 Zillman, D., 55

Taylor, C., 5