The recurring reproach to reason

Today, I finished reading Andrew Scull’s Madness in Civilization: a cultural history of insanity, which has prompted a few posts here and here. The book ends with a series of falls from grace of modern ways of thinking about madness; psychoanalysis becomes stranded with its limitation to a small elite, only to find itself as defined as irrelevant to the great suffering of the most severely mentally ill; then the great disappointments of the evacuation of the asylum, seen as the great enemies of freedom, the great bankrupting social shames, but without any conscientious attention to the community care of the most unwell; and finally, the descent into confusion and denial of the Diagnostic and Statistical Manual itself, which in its fifth edition, was abjured by Robert Spitzer and Allen Frances, the architects of its earlier editions.

Out of the collapse of the great encyclopaedia of the disordered mind, there emerged a new project – to fix all mental illness to single biological causes. Led by the Institute of Mental Health in the USA the new scientists of the brain disavowed the DSM’s study of symptoms to search for a more fundamental biological mechanism. Thomas Insel said  “As long as the research community takes the DSM to be a bible, we’ll never make progress. People think everything has to match DSM criteria, but you know what? Biology never read that book” (quoted Scull, p 408).

Rather than a descriptive symptomatology, the new neuroscience believed they could build a diagnostic system on firm biological foundations. But they were to be disappointed. Despite the flashy images of the brain in action, they came no closer to really understanding the mysteries of the disordered mind or much beyond the routines of the ordered mind. And the reason is in part at least that the human mind, and madness as among the most potent expressions of that mind, is one part biology, two parts culture.

So Scull notes that the metaphysical wager that madness is an illness explicable by the body alone has not paid off. Our cures can be neither solely mental nor merely medical. They must embrace the cultures that temper, limit and excite the voices of madness within us. It is not that the pills or biological explanations will not play some role. “But will madness, that most solitary of afflictions and social of maladies, be reducible at last to biology and nothing but biology?” (p 411)

No, Scull replies:

The social and cultural dimensions of mental disorders, so indispensable a part of the story of madness in civilization over the centuries, are unlikely to melt away, or prove to be nothing more than epiphenomenal features of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been. It remains a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilization itself. (Scull, p 411)

 

Strange salt

Strange salt

All I’ve suffered, and all the suffering I’ve  caused, might have arisen from the lack of a little salt in my brain.”

Robert Lowell

I have been reading Kay Redfield Jamison’s Robert Lowell. Setting the River on Fire: a study of genius, mania and character. It is a lusciously detailed and clinically informed study of Lowell bipolar disorder, its treatments and the endurance of his writing through the many crises his madness bestowed on him.

In the late 60s Lowell began to take lithium for his illness. Lithium, this strange and ancient salt, would change Lowell’s experience of illness and mania. For the next 15 years the frequent, yearly or more, attacks of mania would subside. These attacks had harrowed Lowell’s soul and left him with a constant fear of the recurrence of mania. Jamison insightfully compares the trauma of mania or other psychotic episodes to the trauma of war. After lithium Lowell could live through a late peace.

There is a debate about the quality of Lowell’s poetry in these years of less strife and torment. Jamison takes the view the lithium gave Lowell more years to write without the ravages of madness. Jamison can speak with authority. She has known those manias and the falls, and has written a wonderful account of her own descent as a psychiatrist into her personal bipolar hell. I share her view, knowing in my own life how a little pill can school an errant mind.

Surely poetry, literature, art do not demand the sacrifice of the poet, writer, artist, prophet to the destructive gods of madness. Surely we can shift the inner circles of body and mind, just as we remake nature with culture which is after all part of nature. Surely we can make this small offering of a little salt or a pill to appease the gods of destruction.

The Great Confinement

The Great Confinement

Image Source: photograph, Sarah Lee, Bethlem Museum of the Mind exhibition, The Guardian

From Keats, Hyperion:

Just at the self-same beat of Time’s wide wings
Hyperion slid into the rustled air,
And Saturn gain’d with Thea that sad place
Where Cybele and the bruised Titans mourn’d.
It was a den where no insulting light
Could glimmer on their tears; where their own groans
They felt, but heard not, for the solid roar
Of thunderous waterfalls and torrents hoarse,
Pouring a constant bulk, uncertain where.
Crag jutting forth to crag, and rocks that seem’d
Ever as if just rising from a sleep,
Forehead to forehead held their monstrous horns;
And thus in thousand hugest phantasies
Made a fit roofing to this nest of woe

I have taken up again, after a break of two months, Andrew Scull’s Madness in Civilization: a cultural history of insanity. Here I learn that the archetypal lunatic asylum of the English speaking world, Bedlam or Bethlem Hospital , featured two large statues on plinths at its gates. These statues (pictured above) were of the figures of melancholy and raving madness. Melancholy madness lay imprisoned and disabled by his sadness. Raving madness, full of impotent torrents hoarse, lay shackled. These two statues, according to Scull, were alluded to by Keats in his poem of the fall of the titans, Hyperion, which I confess I have not read until prompted to by Scull’s account. They appear as the bruis’d Titans, who make a fit roofing for this nest of woe.

Whether we know them as asylums or mental hospitals or rehabilitation clinics, these places, which I have known as a visitor, but not a patient, have long been nests of woe. But Scull does a fine job of showing that they can at times be more than that, and that beneath the lurid and dark imaginings, the grotesque exploitation of the insane and the infirm for profit or for poetry, there are other motives and other experiences of caring and protection in these places. Of course, he does not minimise the cruelty and the suffering known in these places, but he also sees the compassion of those who cared and sought to find a place of refuge for their ill family members, and, with a modern perspective, sees the struggle of families in a world with few supports to take care of their mad members and to protect all who knew them from their worst excesses.

So, where the French radical literary tradition celebrated de Sade as the great libertine whose texts speak of excess and transgression that defy the law that sought to confine him with lettres de cachet, Scull gives attention to his despairing mother-in-law who saw her daughter lost in de Sade’s fantasy world and betrayed by de Sade’s affairs with her sister and many prostitutes. So Madame de Montreuil lured de Sade with a ruse to Paris, where she confined him in the Chateau de Vincennes and then the Bastille. Every loving family member of a person who is experiencing the extremes of psychotic behaviour can understand what she did, without recourse to Foucault’s grand myth of resistance to reason, the Great Confinement. Indeed this radical literary tradition celebrating de Sade culminated in Foucault’s celebration of the remorseless libertine in both his texts and his life.

This myth, Scull shows, was mistaken about the true historical circumstances. The idea that Foucault put forward, that in the seventeenth and eighteenth centuries, through a strange shifting of symbols and discourse in the minds of Western man (since Foucault did indeed think in such terms), there was a Great Confinement of the insane “vastly overstates the true state of affairs.” (p 127) The insane were a small and secondary population in the great congregations of the broken in the new French general hospitals, such as the Saltpetriere. Even more so in the rural Europe, most of the mad who were confined were a danger to themselves or others, and most the mad were dealt with, often inadequately, within families, poor houses or religious institutions.

Still the image created by Foucault, in that strangely mesmerizing yet unsatisfying book,  Folie et Deraison (translated as Madness and Civilization in English), has an enduring magic. “By a strange act of force, the classical age was to reduce to silence the madness whose voices the Renaissance had liberated, but whose voices it had already tamed,” Foucault wrote (Madness and Civilization, p 38). For me this grand gesture of retrieving from confined silence the voices of madness has always had a strange power. It has made me overlook all the errors and inconsistencies of Foucault’s argument. It has made me pass over the crude recycled Marxism of Foucault’s interpretation of the great confinement as an act of power asserting order.

But I cannot overlook this any more. There it is, in his text, the absurd statement that the Hopital General (apologies for no accents or diacritical marks since I do not yet know how to produce them from my keyboard) and all the professions of medical care for the insane “had nothing to do with any medical concept. It was an instance of order, of the monarchical and bourgeois order being organized in France during this period.” (p. 40) And later, “Confinement … is a ‘police’ matter. Police, in the precise sense that the classical epoch gave to it – that is, the totality of measures which make work possible and necessary for all those who could not live without it…. What made it necessary was an imperative of labor. Our philanthopy prefers to recognize the signs of a benevolence toward sickness where there is only condemnation of idleness” (Madness and Civilization p 46).

So Foucault turns all the complex storm of emotions, thought and practice provoked by the still deeply mysterious presence of madness in our lives to an old-fashioned Marxist conspiracy theory that condemns the bourgeois in a stance of radical defiance. As Roger Scruton says in his essay on Foucault in Fools, Frauds and Firebrands, Foucault “devoted his work to unmasking the bourgeoisie, and showing that all the given ways of shaping civil society are reducible in the last analysis to forms of domination.” In the end, this rhetoric is helpless before the real experience of falling into madness or caring for a loved one who is mentally ill.

Scruton also identifies the enduring power of Foucault’s writings. His essay is a sensitive and remarkable tribute, yet a scathing critique. He writes of Foucault with a generosity and admiration not dispensed on other fools, frauds and firebrands, such as Sartre, Habermas or the entirely despicable Jacques Lacan. “His imagination and intellectual fluency,” Scruton writes,”have generated theories, concepts and insights by the score, and the synthesising poetry of his style rises above the murky sludge of left-wing writing like an eagle over mud-flats.” He identifies that Foucault’s great book on madness retells the Hegelian master-slave story as a conflict between reason and madness, and it is perhaps my own experience of struggling to find my way between these two experiences that had led to my long enchantment with Foucault’s metaphors and my long search through his radical pantheon of mad anti-gods. As Scruton writes from the revolt of the Romantics and the early modernists through to the twentieth century:

Madness is out of the cage, and confronting us with our truth. At the end of Foucault’s drama the gods of the French post-war Olympus enter stage left, to stick out their tongues at the bourgeoisie in the stalls. Goya, de Sade, Holderlin, Nerval, Van Gogh, Artaud, Nietzsche, all are proof, for Foucault, that the voice of unreason (deraison) can no longer be silenced, and that the reign of bourgeois normality is over.” (Scruton, Fools, Frauds and Firebrands)

This great dreamt titanic struggle between shackled raving madness and its captor, ordinary life has both sustained me and led me many times astray. Still, I feel Foucault could only have written this great book by knowing the borderlands of madness and reason from the inside, and this experience speaks in the poetry of his style in a way that his drier and more pedantic critics cannot attain, despite all their evidence and good sense.

Yet today, I let it go in the knowledge that the voices of madness have never wholly be silenced nor confined. So instead of Keats’ epic vision of madness, as much a vision from the outside as the confining, caring doctors in Foucault’s own poetic epic, let us recall that even in an asylum, with medical confinement, the voice of John Keats’ near contemporary, John Clare, could still speak and break the silence, with a tone quite different to Artaud’s obscene laden rants, and in a way that reaches to every one who writes, and so asserts their being, however diminished by the vast shipwreck of any life. Here, in closing, is John Clare’s poem “I am”.

I am (John Clare)

I am: yet what I am none cares or knows

My friends forsake me like a memory lost,

I am the self-consumer of my woes –

They rise and vanish in oblivious host,

Like shadows in love’s frenzied, stifled throes –

And yet I am, and live – like vapors tossed

Into the nothingness of scorn and noise,

Into the living sea of waking dreams,

Where there is neither sense of life or joys,

But the vast shipwreck of my life’s esteems;

Even the dearest, that I love the best,

Are strange – nay, rather stranger than the rest.

I long for scenes, where mam hath never trod,

A place where woman never smiled or wept –

There to abide with My Creator, God,

And sleep as I in childhood sweetly slept,

Untroubling, and untroubled where I lie,

The grass below – above the vaulted sky.

John Clare (composed some time between 1842-64 in Northampton General Lunatic Asylum, now St Andrew’s Hospital).)

john-clare

Going sane writing

02 adamphillipspix

Adam Phillips says somewhere, perhaps in one of his intriguing essays, perhaps in an interview with the Paris Review, that writing is for him “an experiment in what your life might be like if you were to speak freely.”

It is also a description he gives, in another way, to the process that goes on in the course of psychoanalysis and many other psychotherapies; for fifty minutes you can speak freely and know there is an audience to catch you, to cradle you, to correct you, to chase you to the deepest part of your self.

Phillips’ essays are intriguing for three reasons: their style; the tacit knowledge of the psyche that he brings to them; and his own practice of writing.

The style reflects the pleasure that Phillips states as the only real purpose of his writing. Sentences roll on through enigmas, with never a hectoring voice or a pedantic explanation. Making beautiful sentences is the point of the exercises, and Phillips is true to the essay’s exploratory and experimental genre, playing with and teasing out the silken strands of our stories with which we bind our inner lives. The simple play of his style is there in the title of Going Sane, pleading the paradoxical case that though insanity is well known, the course of developing into a sane person is not. His essays are, like Montaigne’s, peppered with enigmatically selected quotations that point always to this strange artwork that we all practise of making sense of our lives. The epigraph opening Going Sane  is from Baudelaire’s Intimate Journals: “if, by some mischance, people understood each other, they would never be able to reach agreement.”

This deep, tacit knowledge of the strange workings of the psyche makes Phillip’s essays worth reading, where an equivalent stylist’s musings on fluff and fashion or the latest dilemmas of choice in politics are not. Though many of us have had experience of psychotherapy, much that is written about it does not register its subtle entanglement with the imagination. Here Phillips’ sense of style makes him the best ambassador psychoanalysis has ever had. Confidences are not breached, but he does gently share the insights of years of listening to the enigmas and dilemmas of his patients, for whom, he says somewhere, life does not work, and so it is for all of us from time to time.

This unique perspective is also seen in his practice of writing. It is not planned, except that he has a routine that he follows. Every Wednesday he sets aside to write, while maintaining his other profession of therapist. He writes only what pleases him, and is not concerned to persuade or badger or entertain. He claims that the topic of each of his essays or talks is formed in response, and at the moment, of the demand. It is in its own way his mirror of his patients talking out loud, not now as the patient but with a kind of free association of the mind of a very literate and cultured psychoanalyst.

It is this quality of his writing as a free experiment that I most admire; a release of the mind to think on the page; to think freely with compassionate attention to an audience, connected by an unspoken background belief that we do not share stories but share the same endeavour to share stories; but without wanting to force himself into an invented image of the public or marketers. The advice on how to write, how to write to go sane, that began this post is a practice that I will bring to bear on my own writing, with a different professional background, requiring suspension of a whole different set of restrictions on speaking freely.

Madness & History

I am reading Andrew Scull’s Madness in Civilization: a cultural history of insanity from the Bible to Freud, from the Madhouse to Modern Medicine (Thames & Hudson, 2015). The title is a wink to the English translation of Foucault’s Folie et Déraison, that is Madness & Civilization: a History of Insanity in the Age of Reason. And the wink is not kind. The book in some ways is the culmination of a lifetime’s work by Scull to rectify the errors of Foucault, and, at its core, disputes Foucault’s poetic argument that madness is the shadow of reason, the suppressed transgression that must be put outside the bounds of civilization. Yet this argument is put in a graceless way, characterized by offhand snipes at the philosopher’s scholarly errors, rather than a respectful response to the strange beauty of Foucault’s poetry enclosed in history.

File:Bosch-Narrenschiff.jpg

Source: Wikimedia Commons, Hieronymus Bosch (c1450-1516), Das Narrenschiff

Take, for example, Scull’s brief discussion of the theme of the ship of fools. Scull notes the image of the Ship of Fools was created as a literary trope, as in the 1494 text by Sebastien Brant, which was illustrated by Durer (and can be viewed here http://hdl.loc.gov/loc.wdl/demnbsb.8973). These artists created, Scull writes, “allegorical images which captured the sense of the mad as liminal figures, haunting the imagination, lurking half-seen on the very margins of civilized existence.” (p 114) So striking were these compositions and images, Scull acidly writes, “that, six centuries later, they would tempt the famous French philosopher and historian Michel Foucault (1926-84) into embracing the wholly mistaken notion that these powerful paintings were representations of something real, instead of merely an artistic conceit.” (p 115)

That closing sneer – an artistic conceit – betrays the weakness of Scull’s book. It struggles to convey the experience of madness, the imaginative world of insanity, from both sides of the borderlands of reason, and is heavy with real context, reprising the history of the civilization in which the mad dwelt, and light on deep appreciation of its claimed topic – the culture of insanity. Its early chapters, and I am just part way through, tell us much background about empires and historical developments, following a tediously Eurocentric course, but are surprisingly thin on elaborating the images, stories and voices of insanity. If Scull had been prepared to question why a mere conceit exercised such a hold on the imagination, as seen in the selection of topic by artists and the popularity of the images and books, then he might have written a book with more of the poetic power of Foucault’s Madness & Civilization. Instead he seeks to tame the images of madness, to school the wild fertility of its symbolism with the dull discipline of pedantry, and domesticate madness securely within civilization, no longer a threat, but a “fundamental puzzle, a reproach to reason, inescapably part and parcel of civilization itself.” (p 411)

In contrast to Scull’s desultory dismissal of the imaginative resonance of the Ship of Fools, Foucault teases out the image and the social practice of the expulsion of the mad, balancing, if sometimes in too grandiose prose, the mundane realities and the flight of the symbols. He notes at the outset, despite Scull’s uncharitable sneer,  that it is a literary composition, possibly derived from the Argonaut cycle, and part of great mythic themes, revived and rejuvenated in the Renaissance. He does claim that these images, however, had a real existence, but the text is blurry about whether this reality is in the form of a boat (he gives one or two examples) or in the form of symbolic and practical expulsion. “Madmen then led an easy wandering existence. The towns drove them outside their limits; they were allowed to wander in the open countryside, when not entrusted to a group of merchants and pilgrims.”  (p. 8) What matters is less the form of transportation than that “the expulsion of madmen had become one of a number of ritual exiles.” (p 10)

But for a cultural history of insanity, the symbolism of an image is as important as the realities of its more humdrum real world enactment. And it is on the meaning of this crossover – the place of the Ship of Fools in registering how people imagined madness in history – that Foucault dwells on. And so this passage, which even now 35 years after reading its strange poetry, I recognise its importance for my own exiles to the borderlands of reason:

Navigation delivers man to the uncertainty of fate; on water, each of us in the hands of his own destiny; every embarkation is, potentially, the last. It is for the other world that the madman sets sail in his fools’ boat; it is from the other world that he comes when he disembarks. The madman’s voyage is at once rigorous division and an absolute Passage. In one sense, it simply develops, across a half-real, half-imaginary geography, the madman’s liminal position on the horizon of medieval concern –  a position symbolized and made real at the same time by the madman’s privilege if being confined within the city’s gates: his exclusion must enclose him; if he cannot and must not have another prison than the threshold itself, he is kept at the point of passage. He is put in the interior of the exterior, and inversely. A highly symbolic position, which will doubtless remain his until our own day, if we are willing to admit that what was formerly a visible fortress of order has now become the castle of our conscience. (p 11)

This passage is history as poetry, with its marked words denoting a private symbolism of special importance to the writer, and its evocation of a modern dilemma of being trapped within the prisons of our rational minds. It reminds me of Weber’s reference to the iron cage of rationality and vocation that holds us. It evokes the manifestation of madness in history in a way that is beyond the powers of Scull’s more pedestrian imagination. To write of madness in history is a special responsibility: to prowl these borderlands and to come back and speak truthfully of the fears and the beauty, and also the simple mundane practicalities of what you find and how you experience it. It is not a challenge that can be readily undertaken within narrow academic conventions, and it is not a challenge that Scull rises to. Scull domesticates madness with scholarly precision to a trite chronology of (Western European) civilization; Foucault reanimates the history of madness poetically, with all the necessary errors of imaginative speech.

Source: Badius, Josse, 1462-1535.Stultiferae naves

 

 

Some measure of insanity

Let me simply record this statement from Donald Winnicott, which I have taken from the end of Adam Phillips’ short book on the enigmatically wise child-doctor and psychoanalyst:

If I want to say that Jung was mad, and he recovered, I am doing nothing worse than I would do in saying of myself that I was sane and through analysis and self-analysis I achieved some measure of insanity. Freud’s flight to sanity could be something we psychoanalysts are trying to recover from, just as Jungians are trying to recover from Jung’s ‘divided self’, and from the way he himself dealt with it.

The phrase -“I achieved some measure of insanity” – is the beautiful bell in this thought.