Language for Those

Who Have Nothing

Mikhail Bakhtin and the
Landscape of Psychiatry
COGNITION AND LANGUAGE
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THE COLLECTED WORKS OF L. S. VYGOTSKY
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LANGUAGE FOR THOSE WHO HAVE NOTHING
Mikhail Bakhtin and the Landscape of Psychiatry
Peter Good
LANGUAGE, THOUGHT, AND THE BRAIN
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PSYCHOENVIRONMENTAL FORCES IN SUBSTANCE ABUSE
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Language for Those
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Mikhail Bakhtin and the
Landscape of Psychiatry
Peter Good
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For Kit
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.
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.
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.
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, 1981.
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.
P. M. Medvedev, The Formal Method in Literary Scholarship, trans.
Wehrle A. J., Cambridge, MA., Harvard University Press, 1985.
V. N. Volosinov, Freudianism: A Marxist Critique, trans. Titunik, I.R.,
New York, Academic Press, 1976.
AH
CMF
DiN
EN
FM
FR
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.
V. N. Volosinov, Marxism and the Philosophy of Language, trans. Matejka
L. and Titunik I.R., Cambridge, MA., Harvard University Press, 1986.
Mikhail Bakhtin, Problems ofDostoevsky's Poetics, trans. and ed. by Caryl
Emerson, Minneapolis, University of Minnesota Press, 1984.
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.
MPL
PDP
PND
RAHW Mikhail Bakhtin, Rabelais and His World, trans. Iswolsky H.,
Bloomington, IN., Indiana University Press, 1984.
Mikhail Bakhtin, Speech Genres and Other Late Essays, trans. McGee V.,
ed. Caryl Emerson and Michael Holquist, Austin, University of Texas
Press, 1986.
Mikhail Bakhtin, Toward a Philosophy of the Act, trans. Liapunov, V., eds.
Michael Holquist and Vadim Liapunov, Austin, University of Texas Press,
1993.
SG
TPA
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
others response.
And herein lies the basis of Bakhtins 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
x
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
psychiatrys 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 Bakhtins 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 ones own
bodily standing. Words sometimes need different bodies in order to live and
Preface xi
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.
Bakhtins 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
Introduction 1
Preamble 1
Bakhtin 2
The Material Bodily Sphere 6
What Potential is Offered to the Traveller by this Realism? 8
10
Bakhtin and the Psychiatric Landscape
15
The Official Landscape of Psychiatry
Chapter One
The Chronotope 21
The Care Chronotope 23
The Patient Chronotope 27
Whose Time is it and to Whom does it Belong?
28
Imposed Time 29
Chapter Two
I Need to Know Where I Stand?
The Official Languages of the Care Chronotope
33
The Official Voice 36
Chapter Three
The Ringmaster and Laughter in the Care Chronotope
47
Polyphony 48
Anecdotes 49
Method 51
xiii
xiv Language for Those Who Have Nothing
Status 52
Response 52
53
Humour and Laughter as Initiation 56
Humour and Laughter The Patient Cluster 60
The Display of Madness 62
Summary Discussion 68
Targets 53
Humour and Laughter -The Student Cluster
Chapter Four
Dialogues of the Classical and Grotesque Body:
The Unofficial Terminology of the Care Chronotope
73
The Re-arrangement of the Body
74
Terror and Care 77
Sleeping Words 80
The Smoothing-out of Official Ends by Unofficial Means 83
The Surplus of the Third
85
The Aesthetics of Fragmentation 88
Discussion and Dialogue 91
Chapter Five
Encounters with the Grotesque 97
The Distractions of Seeking Grotesque Definition 98
Mrs Drydens Pear 103
The Primary Position 104
The Secondary Position 106
Discussion and Dialogue 106
Alibis and Responsibility 108
Chapter Six
Madness and the Grotesque Chronotope
113
Discovered Fellowship 116
Contents xv
Chapter Seven
The Practitioner Patients 123
Primary and Secondary Positions of the Care Chronotope 125
No-mans Land 128
Through the Gates of the Patient Chronotope 130
The Unofficial Landscape 132
Discovered Fellowship 137
Chapter Eight
The Pseudopatients 143
Finding Oneself in No-mans-land 147
Encountering the Grotesque 149
The Timespace of the Patient Chronotope 151
Clinging to the Wreckage: Space and Invisibility 153
Through the Gates of the Patient Chronotope: Discovered
Fellowship 156
The Case of William Caudill and the Circles of Parody 160
The Circles of Parody 162
An I-experience or a We-experience? 169
Pseudopatients: Summary and Discussion 172
Chapter Ni ne
The Pseudopatient 181
The Visit 184
Intermezzo 191
Admission 192
Discussion 202
Timespace 203
Language 205
Found Fellowship 208
Chapter Ten
Consummation 211
Polyphony 212
Icons 214
xvi Language for Those Who Have Nothing
What Relevance has Polyphony to Psychiatry?
What Potential is loaned to the Practitioner by Polyphony?
216
219
Appendix One 227
Student Cluster 227
Patient Cluster 231
Competing Theories 235
Miscellaneous 236
Appendix Two 237
Unofficial Terminology Collected from the Introductory
Lectures to Psychiatry given to Medical Students 237
Index 239
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
2 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:
Medvedevs The Formal Method in Literary Scholarship, and Voloshinovs
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. Bakhtins 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,
Bakhtins work began to be published and, in the early 70s, 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 Neo-
Kantian 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
4 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.
Bakhtins 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 Hirschop
3
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, Bakhtins 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 Bakhtins 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 Adams 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 Bakhtins dialogism can be attributed to a
bodily standing pre-occupied with privacy and individuality.
But Charles Taylor
6
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 Taylors 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. Bakhtins
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 todays 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.
6
THE MATERIAL BODILY SPHERE
Language For Those Who Have Nothing
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 bodys 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 Stam
8
has identified the prominence of aural and
vocal metaphor in Bakhtins thinking. He describes how Bakhtins 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 mutually-
dependent 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 Serress
9
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 Serress metaphor from chaos
we are given a complementary insight into the ever-becoming forces of the
Material Bodily Sphere. But in complying with Serress 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 Bakhtins work on the carnival he noted that Rabelaiss 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 TOTHE 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. Bakhtin
11
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 Bakhtins 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 a permissible 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. Bakhtins 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 Bakhtins 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. Harrison
18
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
White
19
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 Jasperss General
Psychopathology
20
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, Jasperss work was to have a profound
influence on British psychiatry,
22
particularly through the work of Mayer-
Gross 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 psychopathology
24
is managed. According to
Manfred Spitzer, Jasperss legacy can be shown by the fact that some of the
basic principles of todays psychiatry can be traced back to his thoughts.
,25
As a hero Jaspers remains a significant voice on the psychiatric landscape.
Jasperss 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-Taylors 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 Jasperss greatest contribution to the
psychiatric landscape has been the consolidation of the practitioners
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
Jasperss great triumph lay in giving
a scientific credibility to the practitioners 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 practitioners 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 practitioners
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 of his 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 practitioners
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.
Jasperss 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 practitioners standing as well as on the
14
Language For Those Who Have Nothing
patients 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. Jasperss
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 ones
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. Psychiatrys 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 Jasperss 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 the function 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 anothers 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 ones 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.
Bakhtins 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.
1
Groys, B., Nietzsches influence on the non-official culture of the 1930s, in Nietzsche and
Soviet Culture: Ally and Adversary, ed. Rosenthal, B.G., Cambridge, Cambridge
University Press, (1 994) 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)
4
see Ware, T., The Orthodox Church, Harmondsworth, Penguin, (1983) for the most
5
Clark, K. and Holquist, M., Mikhail Bakhtin, Cambridge, MA., Harvard University Press,
6
Taylor, C., The Ethics of Authenticity, Cambridge, MA., Harvard University Press, (1991)
7
RAHW: p18.
8
Stam, R., Subversive Pleasures: Bakhtin, Cultural Criticism and Film, Baltimore, Johns
Hopkins University Press, (1 989).
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, ( 199 1 ).
p75.
accessible introduction to Orthodox thought.
(1994) p123.
p3.
10
EN: p20.
11
RAHW: p24.
13
DiN: p272
l4
ibid: p276.
15
TRDB: p293.
16
DiN: p292.
17
EN: p24.
18
Harrison, P.J., General Psychopathology: Karl Jaspers, A Trainees View, in British
l2
SG: p97.
Journal of Psychiatry, Vol. 159, (1991) pp300-3.
Introduction 19
19
White, A,, Carnival, Hysteria and Writing: Collected Essays and Autobiography, London,
Clarendon Press, (1993).
20
Jaspers, K., General Psychopathology, Manchester, Manchester University Press, (1 963).
First published in German in 1913. The 1963 edition was the first English translation.
21
Shepherd, M., Karl Jaspers: General Psychopathology, in British Journal of Psychiatry,
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 of the 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 of abnormal 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
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
39
SG: p16.
Psychiatry, Vol. 114, (1968) p1313. First published in German in 1912.
Associations, Vol. 5, Part 3 (No. 35), (1995) pp275-88.





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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.
JimForest
1
As the multiplicity of voices suggests the possibility of many different
Is, so chronotopes
2
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
22
Language For Those Who Have Nothing
general scepticism towards Newtons 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 Einsteins 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 Einsteins 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-
The Ch ron otope 23
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 dentists 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
h is t or y .
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, psychiatrys 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
24
Language For Those Who Have Nothing
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 that the value of official psychiatric 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 psychiatrys 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 yet-
to-come dimension. And these voices drain and emasculate the future of its
potential. The temporal descriptions
10
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. Morgan
11
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 Morgans 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 Doctors
frustrations about his present circumstances can be weighed against
Bakhtins 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:
The Chronotope 25
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 associations presidents remarks
indicates that the sense of coming ofage 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 psychiatrys past heroes are brought to bear on present anxieties and are
used to fuel further enthusiasms. But the tragic paradox of the Care
Chronotopes 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 others 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 bodys 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.
26 Language For Those Who Have Nothing
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
bodys 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 oclock on a Monday morning. Thin crab-paste sandwiches
eaten at ward 22s 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, its 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
The Chronotope 27
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 ones 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
28 Language For Those Who Have Nothing
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 patients 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 folk-
belief 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. Morrall
16
Although I will discuss in the next chapter Bakhtins 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
The Chronotope 29
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 ones own dominant
standing. Elias Canettis commentaries on the ways political structures
establish themselves carry a strong resonance with Bakhtins 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
30 Language For Those Who Have Nothing
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 twice a day
t. d. s. ter die sumendus three times a day
o. n. omni nocte every night
q. d. quarter die 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 Branthwaite
18
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
couldnt fit me in at the hospital for that exact period of time as it was too
much messing about.
19
The Chronotope 31
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.
The formula repeats itself.
1
Forest, J. Praying with Icons, Maryknoll, New York, Orbis Books, (1997) pp35-6.
2
Bakhtin's chronotope is made up from the Greek chronos, meaning time, and topos,
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.
11
Morgan, H.G., 'Suicide Prevention: Hazards on the Fast Lane to Community Care', in
12
FTC: p 147.
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
17
Canetti, E., Crowdsand Power, Harmondsworth, Penguin, (1973).
meaning space.
10
SG: p11
British Journal of Psychology, Vol.160, (1992) pp149-53.
Nursing, Vol. 15, No.2, (1995) pp16-19.
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.





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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 of Judaism grown impatient at the everlasting delay of
the messianic came strange fruit.
George Steiner
1
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 Bakhtins 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 Bakhtins 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 Schools clearest
exposition of official language can be found in Marxism and the Philosophy
of Language a book authored by V. N. Volosinov, but later claimed by
Bakhtin to be a work of his own.
2
Volosinovs work is perhaps the most
forceful challenge to Saussures systematic use of langue as the means of
analysing language. Marxism and the Philosophy of Language objects to
33
34 Language For Those Who Have Nothing
Saussures 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 clear-
cut 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
reality
3
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 individuals inner creativity, are now radically re-
positioned as being half-ours, half-someone elses.
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.
I Need To Know Where I Stand 35
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
36 Language For Those Who Have Nothing
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 words 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, Bakhtins 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. Bakhtins 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
I Need To Know Where I Stand 37
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 Bakhtins socio-linguistic tensions and marry them to Foucaults
ideas of continuity and discontinuity, we can, very broadly, reach a common
point of reference in the notion of Foucaults 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. Foucaults own history of psychiatry directly
challenged the received view of a progressive and linear development of
psychiatry. His history broke up an otherwise continuous stream of progress
with sudden and dramatic events. In Madness and Civilisation
13
Foucault
argued that those disciplinary structures which hitherto had carried true ways
of seeing and speaking Bakhtins 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 Nietzsches 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, History
16
Foucault lays 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
38 Language For Those Who Have Nothing
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 Bakhtins 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 languages 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 Jasperss Chair of Psychiatry at Heidelberg,
anxious to distance armchair Psychiatry from the province of real
scientific theories of clinical practice:
I Need To Know Where I Stand 39
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 psychiatrys 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 practitioners standing at every level of clinical encounter. According to
Bakhtins 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 irrelevant
21
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
40
Language For Those Who Have Nothing
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 Heidelbergs 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 chatter
23
Jasperss 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 Jasperss ambition.
Here are two eminent psychiatrists of the 1980s:
[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
I Need To Know Where I Stand 41
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 value for money and a tidy administrative scheme
29
Peter Huxley, using the same voice, updates the Jasperss call for
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 other
30
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
tidiness, unity and clarity:
42
Language For Those Who Have Nothing
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
readers 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
I Need To Know Where I Stand 43
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 psychiatrys 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 Bakhtins
observation that all language is ideologically saturated.
33
Bakhtins 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 Bakhtins 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:
44 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. Morgans 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. Morgans 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 appeasements
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 Spitzers reluctance to engage a Chinese philosopher in debate
illustrates the sheer difficulty in reconciling the effect dialogism has on
high/low binaries. Spitzers 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 ones 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
I Need To Know Where I Stand 45
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
2
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.
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.
Martin's Press. (199 1 ), p39
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, (1 993).
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 of Psychiatry, Volume
I, General Psychopathology, eds. Shepherd, M. and Zangwill, O.L., Cambridge,
Cambridge University Press, (1983) p212
22
DiN: p271
46 Language For Those Who Have Nothing
23
Jaspers, K., Philosophical Autobiography, in The Philosophy of Karl Jaspers, ed. Schilpp,
24
Grinker, R. R., Roy R. Grinker Sr. in Psychiatrists on Psychiatry, ed. Shepherd, M.,
25
Watt, D., David Watt in Psychiatrists on Psychiatry, ed. Shepherd, M., Cambridge,
26
HMSO., The Health of the Nation: A Consultative Document for Health in England,
27
HMSO., The Health of the Nation: A Strategy for Health in England, London, HMSO.
28
HMSO., Creating a Common Profile for 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 andStatistical Manual ofMental Disorders, 4th edition, Washington,
American Psychiatric Association, (1994) pg. xiii
32
ICD10., Classification ofMental and Behavioural Disorders, 10
th
Revision, Geneva, World
Health Organisation, (1993) pg. vii
33
DiN: p271
34
MPL: p41
P. A, , Illinois, Open Court Publishing Company, (1957), p16
Cambridge, Cambridge University Press, ( 1982) p33
Cambridge University Press, (1982) p197
London, HMSO, (1991) p87
(1993) p86
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 Nash
1
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
48 Language For Those Who Have Nothing
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.
Dostoevskys 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, movedfrom 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 authors 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
The Ringmaster and Laughter in the Care Chronotope 49
further characteristic. For Bakhtin, Doestoevskys 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 Dostoevskys novels, to be in a constant
dialogue: A plurality of independent and unmerged voices and
consciousnesses, a genuine polyphony of fully valid voices.
5
The
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 authors position is not one of a passive and detached spectator.
The Polyphonic novel is always conscious of anothers standing and
encourages encounters whereby characters can argue with the author who
created them. Such relationships can only be achieved through the authors
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. Polyphonys 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
50 Language For Those Who Have Nothing
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
of her first 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 mans 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 of a 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 of functioning,
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
authors 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
The Ringmaster and Laughter in the Care Chronotope 51
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.
Bakhtins 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, its 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 Bakhtins threshold chronotope:
9
- the breaks in a
52 Language For Those Who Have Nothing
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
The Ringmaster and Laughter in the Care Chronotope 53
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
54 Language For Those Who Have Nothing
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: Dont 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: Dont 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
The Ringmaster and Laughter in the Care Chronotope 55
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. Zillmans 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 students 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
worlds reduction of laughters 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 laughters 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 laughters embrace a
body continues to respond to an ancient need for the safety of human
proximity. Laughters 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,
56 Language For Those Who Have Nothing
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 years 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 wasnt 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 Chronotope
17
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
The Ringmaster and Laughter in the Care Chronotope 57
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 Bakhtins
Rabelaisian Chronotope
19
we have a timespace always on hand to mediate
the displacement of one body to another. Bakhtin built the chronotope from
Rabelaiss 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 adepts gaze was constantly voiced in connections to the
student body: 050Q; You are very quiet, very quiet as a year. Well 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 psychiatrists mysterious powers. It is a sustaining myth
that links the powers of the psychiatrists gaze to be a part of the official
58 Language For Those Who Have Nothing
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 adepts 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 students 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
Bergsons 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 of mind 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; Its not just have a cup of coffee, have a chat
and say there, there (2). Just occasionally the tutor uses humours
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
initiates laughter demonstrates their desire to deflect the tutors anger and
The Ringmaster and Laughter in the Cure Chronotope 59
interpret the utterance in a safer intonation. Humours 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 humours meaning. Equally, the more low scoring laughter
became almost a ritual response to a repetitive motif; a polite communal
reaction that merely acknowledged the tutors a humorous intonation. But
the failure to offer at least a minimal response - to contribute to a communal
reaction - indicates (to oneself, to ones 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 tutors 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
60 Language For Those Who Have Nothing
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 of the 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 Bakhtins 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.
Bakhtins 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 ones 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 Bakhtins 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.
Bakhtins 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
The Ringmaster and Laughter in the Care Chronotope 61
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 Jasperss 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 -bodily excess,
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
62 Language For Those Who Have Nothing
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 practitioners 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.
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 anothers 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 jokes 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.
21
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
The Ringmaster and Laughter in the Care Chronotope 63
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 talk-
show host. Andrea Stulman Dennetts
30
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 pitchers 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.
64
Language For Those Who Have Nothing
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 MacDonalds
31
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 Bethlems economy that the mad were there to
be displayed. Basil Clarkes Mental Disorder in Earlier Britain
34
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 Hogarths famous engraving of
Bedlam depicts a lady and her maid wandering among the hospitals
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
The Ringmaster and Laughter in the Care Chronotope 65
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
SO
37.
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
66
Language For Those Who Have Nothing
allayed by the quiet confidence of the physicians gaze. Audience laughter
is part relief and part awe in the practitioners ability to reduce the patients
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
rational norms: 053Q: Wearing a lot of lipstick, not in line ..... (I); and,
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. A flasher 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 dont 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
The Ringmaster and Laughter in the Care Chronotope 67
between conformity and dissent. The very authority of the Ringmaster
048Q: Families do effect children. Most of you 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
Ringmasters 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 mans 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 physicians
authority. The fact that they both yield to a barely suppressed laughter only
68
Language For Those Who Have Nothing
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 Jaspers
41
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 anothers voice and its
refusal to enter into a dialogue other than in its own voice. At these lectures
I gained a deeper understanding of Bakhtins 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 pre-
conceptions 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.
The Ringmaster and Laughter in the Care Chronotope 69
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
rationalitys 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 Foucaults 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 1980s and I have
played my own part in broadcasting its potency. I am certain Pinels 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 ... Im sorry I dont speak
German.
I have made much of the Ringmasters skill in dramatising the
relationship of one body to another. Because he paraded the body of
madness in a finalised 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
70 Language For Those Who Have Nothing
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.
1
Nash, W., The Language of Humour, London, Longham, (I 985)
2
PDP: p27
3
ibid. p67
4
ibid. p93
5
ibid. p6
6
OSullivan, 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 of the 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 Its 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: p177-8
21
ibid: pI68
22
ibid: p 169
23
Bergson, H., Laughter: An essay on the Meaning of the Comic, London, Macmillan and
24
AA: p27
25
Jaspers, K., General Psycopathology, Manchester, Manchester University Press, (1 963) 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
Co., (1911) p176
The Ringmaster and Laughter in the Care Chronotope 71
30
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
35
ibid: p24 1
36
Masters, A,, Bedlam, London, Michael Joseph, (1977) p47
37
cited in Porter, R., Mind Forgd Manacles: A History of Madness in England from the
34
Clarke, B., Mental Disorder in Earlier Britain, Cardiff, University of Wales Press, (1 975)
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





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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
74 Language For Those Who Have Nothing
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 Vincis 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
Dialogues of the Classical and Grotesque Body 75
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.
Leonardos 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 pots
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 dont 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 Leonardos 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. The bodys anatomy.
2. Clothing.
3. Death.
4. Defecation.
5. Food.
6. Drink and Drunkenness.
7. Sex.
6
Language For Those Who Have Nothing
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 ones peers. Eliot Freidsons Profession of
Medicine
8
gives an excellent example of the professional body being
separated from the Series and reconstructed in a classical mould. Freidson
refers to Florence Nightingales 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 alcohol
9
Miss Nightingales 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
Dialogues of the Classical and Grotesque Body 77
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
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 neo-
classical 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 Brookes
11
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.
The point is an important one.
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
78 Language For Those Who Have Nothing
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 practitioners 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 realisms 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. Laings 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 double-
hind, 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-binds 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 60s, 70s,
and 80s. 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 1980s, the
Dialogues of the Classical and Grotesque Body 79
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 1960s, 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 ofthe 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 Committees
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
Griffiths phrase, dare to see,
15
and come to speak the unsaid and the
80 Language For Those Who Have Nothing
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 Id 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 MacDonalds 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 Shakespeares 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
Dialogues of the Classical and Grotesque Body 81
from the high seriousness of DSM IV down to the low levels of everyday
understanding:
Brief reactive psychosis
Schizophreniform disorder
Undifferentiated Schizophrenia
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 Neaman
20
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 himself or 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 11
th
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.
82 Language For Those Who Have Nothing
To describe someone as possessing airy-fairy ideas implies a similar textual
quality. Old Italian gives us Buffare to puff and, hence, Buffoon.
William Willeford
21
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, 16
th
Century froth on yeast), blow (ones mind), babble, bubble,
blown (hes), 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
Time
23
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
stylistic aura
24
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
Dialogues of the Classical and Grotesque Body 83
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
cripples you* can really cripple you* cure worked like
magic* dabbled* flying feel they are going mad* unable to know

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
what's happening* loony lunatic loss of control not feeling right in
creeps up*
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*
84 Language For Those Who Have Nothing
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 Ringmasters
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 Obsessive-
Compulsive States are shadowed by metaphors drawn from the ancient
notions of possession, intrusion, exorcism, and a hopeful return to Gods
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 patients attention so that he is obsessed by
them against his will [...] they invade a patients 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 Ross
29
Dialogues of the Classical and Grotesque Body 85
[A]n individual plagued by doubts [. . . ] the intrusive and inappropriate
quality of the obsessions
DSM IV
30
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 bedevilled the
obsessional disorders since their clinical inception.
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 smooth-
out 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. Ryklin
32
86
Language For Those Who Have Nothing
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 Hospital
33
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
Dialogues of the Classical and Grotesque Body 87
has the power to mediate between different ways of viewing the world.
According to Jerry Palmer
34
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. Morsons 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
Morsons 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 Ringmasters
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 womans incapacity to tolerate undisguised sexuality becomes the
way of satisfying the tellers 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
88 Language For Those Who Have Nothing
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 Ringmasters
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 long-
stay patients were the type who sit around all day doing nothing but
Dialogues of the Classical and Grotesque Body 89
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:
90
Language For Those Who Have Nothing
all in the head bats in the belfry bee in the bonnet blockhead
bonehead brainless bug conk conked dunce emptyhead fathead
hole-in-the-head madcap numbskull nut nutter nutcase nutty
pinhead thickhead
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 co-
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
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 hyped-
up 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 f at 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
ordinates:
underworld:
Dialogues of the Classical and Grotesque Body 91
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
a quarter of a bubble out of plumb
two cans short of a six-pack
yet to muster a full pack of
two sandwiches short of a picnic
his belt doesn't go through all the loops
steps dont go all the way up to the attic
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
92 Language For Those Who Have Nothing
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 White
45
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 subjects 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 Bakhtins 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 consultants
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
Dialogues of the Classical and Grotesque Body 93
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 but for 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 that falling 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
94 Language For Those Who Have Nothing
silence that harbours its own myriad potentials of response. In the word-
world of the psychiatric landscape unofficial terms leak out along the
corridors of the clinic work to subvert the determination to possess a one-
sided 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 Serress 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.
1
The words appended with an asterisk indicate their use in a lecture. The style of this chapter
2
RAHW: p421
3
ibid: p403
4
ibid: p 163
5
ibid: p32I
6
FTC: p170.
7
ibid: p33
8
Friedson, E., Profession of Medicine New York, Dodd, Mead &Company, (1970)
10
RAHW: p29
11
Brooke, D., The Addicted Doctor, Caring Professionals?, in British Journal of Psychiatry,
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
draws its influence from Rabelaiss practice of loading a text with lists of words.
9
ibid: p61
Vol. 166, (1995) pp149-53
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, (198 1) 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)
Neaman, J., Suggestion of the Devil: The Origins of Madness, New York, Anchor, (I 975)
21
Willeford, W., The Fool and His Sceptre: A Study of Clowns and Jesters and their
22
DiN: p281
23
SG: pp1-9
24
DiN: p293
25
SG: p4
26
RAHW: p432
20
Audience, Baltimore, Northwestern University Press, (1969) p11
Dialogues of the Classical and Grotesque Body 95
27
cited in Clare, A,. Psychiatry in Dissent, London, Tavistock, (1980) p94
28
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., TakingHumour Seriously, London, Routledge, (1 994) p20
35
Morson, G.S., Parody, History and Metaparody, in Rewriting Bakhtin, eds. Morson, G.S.
36
SG: p99
and Emerson, C.. Evanston, Northwestern University Press, (1989) p65
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





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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. Danow
1
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
98
Language For Those Who Have Nothing
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 travellers response. After
giving some account of the grotesque I will go on to propose a primary 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. Bakhtin
2
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 sub-
text of the conflict between a modem selfhood and a much older collective
identity. This argument is at least four hundred years old and Bakhtins
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
Encounters with the Grotesque 99
with the psychoanalytical shaping of the modem self. Freuds study of the
Uncanny
3
transferred Romanticisms 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 grotesques
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
Ringmasters 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 Freuds
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 grotesques legacy is anchored in a social setting that was
central to carnival logic. As a figure it was fixed to the beliefs of folk-
culture 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 its 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
100 Language For Those Who Have Nothing
find it hard to be persuaded by this individualised relationship to the
grotesque. The more compelling explanation is to be seen in the re-
familiarisation 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 schools 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 Hammonds
9
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,
Encounters with the Grotesque 101
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 made free 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
102 Language For Those Who Have Nothing
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 grotesques 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 official finishedness 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 others imagery into nosological
rankings of pathology.
Encounters with the Grotesque 103
MRS DRYDENS 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
travellers 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
Bakhtins reading of Rabelais observes that
the gaping mouth was once universally recognised as a symbol of the all-
consuming unfinishedness of the collective body. Rabelais relishes in
Lucifers 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 Rabelaiss 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:
104 Language For Those Who Have Nothing
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 patients mouth [...], the nurse in
question, also tried to fit into the patients mouth a set of teeth which she
had removed from 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 Drydens bedside was a dialogue resplendent with all the images of
Rabelaiss gaping mouths and impending deaths. Mixed in to the spectacle
was the communal bowl of alien teeth, the re-generative hopes of Mrs
Drydens pear, the authority of the nurses 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
Encounters with the Grotesque 105
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 Drydens 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.
106
THE SECONDARY POSITION
Language For Those Who Have Nothing
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 Wilber
17
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
Encounters with the Grotesque 107
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
Drydens 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 rubberneckers 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 spectators
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 cant
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
and year 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
108 Language For Those Who Have Nothing
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 todays 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 Earths 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. Bakhtins 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 Ware
22
Encounters with the Grotesque 109
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 grotesques 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 cant 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.
Bakhtins 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 starting point 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, modernitys 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
110 Language For Those Who Have Nothing
Bakhtins 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
Bakhtins 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 Bakhtins
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-for-
living, 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. Bakhtins project is to house abstract evaluation
Encounters with the Grotesque 111
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. Bakhtins
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, Bakhtins
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 dont
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 dont 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
real flesh 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
gen era lized h um an being.
Fyodor Dostoyevsky
29
112 Language For Those Who Have Nothing
1
Danow, D.K., The Spirit of the Carnival: Magical Realism and the Grotesque, Lexington,
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 cant beat medical students for tact and sensitivity: the slag of the year
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
15
RAHW: p82
16
TPA: p57
l7
Wilber, K., No Boundary: Eastern and Western Approaches to Personal Growth, Boston,
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.
The University Press of Kentucky, (1995) p34
award has now been ditched, in The Independent, 11 June 1996.
Irregularities at the Ely Hospital, Cardiff, (1 969) pp5 1-3
New Science Library, (1981) p20
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,
26
ibid: p2
27
ibid: p1 1
29
Dostoyevsky, F., Notes from Underground, London, Penguin Classics, (1 972) p123.
Northwestern University Press, (1989) p19
28
ibid: p40
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 Gramsci
1
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
polyphonys range. A process is being rehearsed, one that will prepare me to
step out onto a wilder landscape.
My choice of using R. D. Laings A Ten Day Voyage
2
is guided by the
fact that it is the most notable of modem psychotic narratives. Laings
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 Laings proposal, in the figure of the practitioner, of a
changed relationship to madness, and in turn, to the psychiatric landscape
113
114
Language For Those Who Have Nothing
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 Laings 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. Laings 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.
Bakhtins observations on the threshold symbols of everyday objects are
a useful introduction to Watkinss journey. Doorways, stairways, and
entrances enable a body to pass from one timespace to another but their
Madness and the Grotesque Chronotope 115
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 Watkins 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-mans-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
116
Language For Those Who Have Nothing
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, its a nice day. To Watkins, these simple phrases have
different spatial meanings altogether.
As Watkins 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 [...] Its as if something soft
were dropped into a bag of nails. As a youngster his relationship to the rest
of the ships 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
Watkins 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. Volosinov
8
In this narrative the tension between the private and the public self takes
on a new relevance. Bakhtins commentaries on the Hellenistic public have
Madness and the Grotesque Chronotope 117
a direct bearing on Watkinss 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.
Watkins 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
Laings conclusions to Watkinss journey directly challenged
psychiatrys ability to manage madness. For Laing, Watkinss return to safer
shores was made possible only by the fact that he received comparatively
118
Language For Those Who Have Nothing
mild forms of sedation and he held that psychiatrys 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 clinics 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
post-war recovery. New perceptions of society, induced or otherwise,
suggested that human relationships could be rediscovered through the
medium of love. This is an old message but the air of the late 60s 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 Watkinss 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. Watkinss 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 Watkinss narrative. Laings 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,
Watkinss draws upon the communality of the ships 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 Watkinss discovered fellowship
for my own journeys ahead:
a) The journey partners, the crew, were alongside each other in body and
spirit.
Madness and the Grotesque Chronotope
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,
119
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 Watkinss voyage and compares it to
those ancient pilgrimages undertaken by individual mystics. No lessons are
to be drawn from the social implications of the ships crew. Laing is seeking
heroes. Maybe even beginning here his own eventual journey to the eastern
mysticism. But back in the ordered world Laings 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. Laings 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, Watkinss
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 Watkinss ship. But the resemblance is only artificial. The
crew aboard Watkinss 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 others 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
120
Language For Those Who Have Nothing
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 storms life-threatening power is
briefly made insignificant.
For polyphony there are important questions to be asked from Watkinss
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
polyphonys 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 ones own consciousness into an empathic relationship with
another. Neither is it enough to depend upon a neutral and licensed alibi-for-
living. 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 step-
downs onto the more material levels of the psychiatric landscape. It would
be nave 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.
1
Gramsci, A,, Selections from the Prison Notebooks London, Lawrence & Wishart, (1971)
2
Laing, R.D., The Politics of Experience, Harmondsworth, Penguin, (1967)
3
Siegler, M., Osmond, H. and Mann, H., Laings Models of madness, in Laing and Anti-
Psychiatry, eds. Boyers, R. and Orrill, R., Harmondsworth, Penguin, (1972) p121
Madness and the Grotesque Chronotope 121
4
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.





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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 Sacks
1
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
124
Language For Those Who Have Nothing
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 Watkinss
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
discovered fellowship: 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 womens 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
The Practitioner Patients 125
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 practitioners 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
cartwheels 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 wont be a next time It couldnt
happen to me could it?
Upward, regenerative time
Awakenings Surviving Depression Hope is the Key Metamorphis
Looking Back Learning to Live Beginning to Live Life doesnt
scare me anymore
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
126
Language For Those Who Have Nothing
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 doctors house, the rest put up their
shutters and circulate the comforting notion that the victims illness is the
direct consequence of the sterling qualities possessed by every member of
the caring professions: an excess of virtue, if you 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
The Practitioner Pa tien ts 127
judgmental content of his fellow professionals comments: you of all
people; everyone at the hospital is amazed that you have had a
breakdown; youve studied too much, you were never up to it; Im not
surprised, I always thought you had a weakness, you were far too proud;
What are you going to do now? You cant 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 practitioners 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 self-
fulfilling position of at once being made insignificant yet wanting in
themselves to be invisible to the gaze of the other. A recent MIND survey
7
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
patients:
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
128 Language For Those Who Have Nothing
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. Ive 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 no-
mans-land.
NO-MANS 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
The Practitioner Patients 129
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-mans-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 oclock 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
Visitors 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
didnt understand the rules and regulations.
17
An anonymous doctor,
writing in the British Journal of Psychiatrys 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-mans-
land. 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
130
Language For Those Who Have Nothing
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 patients 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-mans-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
The Practitioner Patients 131
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 clinics 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 doctors 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 of familiarity, drained of the feeling
formerly invested in them.
29
Hughes, too, experiences strange perceptual concepts of spatiality. At
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
times he is convinced he is about to lose his grip:
132
Language For Those Who Have Nothing
they didnt 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
I t 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
The Practitioner Patients 133
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-mans-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, and pitiful.
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
o t h 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.
134 Language For Those Who Have Nothing
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 send-
up of a Sean O'Casey character, she waddled about emitting an
unbroken stream of obscenities 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
The Practitioner Patients 135
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, if you do that again well 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. Youll 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
136
Language For Those Who Have Nothing
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 and friends, Ive 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,
The Practitioner Patients 137
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 didmore
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-mans-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
138 Language For Those Who Have Nothing
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 patients 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 Bakhtins city-state, a Psychiatric Social Worker finds an
enormous strength from within a womans group. The group shares all the
intimate details of each others 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 others 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 Watkinss 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
The Practitioner Patients 139
severity of depression as a wholly destructive illness? And is it not true that
historical commentary has long noted melancholias 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
Janets 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. Grotesques 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
140 Language For Those Who Have Nothing
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?
1
Sacks, O., A Leg to Stand On, London, Picador, (1991)
2
Rippere, V. and Williams, R., (eds), Wounded Healers: Mental Health Workers
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: p8 1.
12
ibid: pp I 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.
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: p 1 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.
34
ibid: p74.
35
ibid: p115.
37
ibid: p103.
38
ibid p 154.
39
ibid: pI5I .
Experiences of Depression, London, John Wiley & Sons, (1985).
19
Hughes, S., Inside Madness i nBritish Medical Journal, Vol. 301, (1990), pp1476-8.
33 ibid: p112.
36
ibid: p81.
The Practitioner Patients 141
40
ibid: p 19.
41
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.
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
Foudraine. J., Not Made of Wood, London, Quartet Books, (1974) p281.
49
University Press, (1 963) p22.





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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 Apeleiuss 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 Apeleiuss 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
144 Language For Those Who Have Nothing
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 Luciuss 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.
Luciuss 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 Luciuss 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 Luciuss journey and herein lies the warning
that polyphony is not just a matter of switching from one abstract
perspective to another: changing a chronotope isnt changing an intellectual
approach; it means changing your life.
In my introduction I proposed that to engage polyphonically with a
faade 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 travellers 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 60s. 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. Hay
4
has described it to be memorable in any
The Pseudopatients 145
psychiatrists career. From a Manchester catchment area of 200,000, and
over a ten-year period, Hays 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
pseudopatients 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 pseudopatients 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 Cuckoos Nest, and the impact of anti-psychiatry.
Pseudopatient research had its own status within the broader cultural events
of the 60s. Secondly, and in part as a reaction to the 60s, psychiatry itself
changed. The new liberalism that filtered onto the landscape substantially
modified the traditional hierarchies of psychiatry by introducing customer-
oriented 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. Rosenhans paper On Being sane in
Insane Places
6
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, Rosenhans 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 Rosenhans 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 Science
7
carried
fifteen letters, each one disturbingly hostile to Rosenhans project, and in the
146 Language For Those Who Have Nothing
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. Rosenhans 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 Bulmer
13
) sounded the
final death knell for pseudopatient research in the early 1980s. 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 disciplines 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 covert
14
and overt
15
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 Redlichs 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 60s. 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
The Pseudopatients 147
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-mans-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. Luciuss 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-MANS-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 Deane
18
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
148 Language For Those Who Have Nothing
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 psychologists
20
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-mans-
land: I feel really destitute; no one has said anything about whats 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-mans-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-mans-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
The Pseudopatients 149
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
Weitzs 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
Rosenhans 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. Rosenhans 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-mans-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 Jung
28
The loneliness of no-mans-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.
150
Language For Those Who Have Nothing
Deanes 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 faade 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 hangmans 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 self-
inflicting 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:
ThePseudopatients 151
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
Deanes 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 wouldnt 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 Rockwell
38
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 Deanes 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
152 Language For Those Who Have Nothing
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. Hughess 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
mens 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 dont use the days
of the week to tell the time, but you say, Oh, that was the day we waited
in the hall for the floor 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
tremendously important.
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 is just the beginning of another long day, an
extension of yesterday which will merge into tomorrow. 9am this
The Pseudopatients 153
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 staff person. For
staff the 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
CLINGINGTO 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 grotesques 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-mans-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-
154 Language For Those Who Have Nothing
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-mans-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 patients 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 couldnt. She doesnt stop, doesnt pay any more
The Pseudopatients 155
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 of their way. Otherwise, there was no attempt at conversation,
no move to find 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 of viewing 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
156 Language For Those Who Have Nothing
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's-
land. 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 first-
year resident was far different from the same ward as I came to know it
while living on it. The patients ' ward is strikingly different from the ward
the psychiatric resident thinks the patient lives on, and surprisingly
different from 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
The Pseudopatients 157
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
Hunters 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 Reynolds 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
dont 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 Reynolds 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
158 Language For Those Who Have Nothing
crazy. I responded, Its 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 Hs 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
couldnt do that. He replied, You cant be expected to do it. It took me
sixteen years to learn how. You cant learn overnight. I turned to the
young patient: We have a lot to learn from theses two, Mr H and Mr
A. The four 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
.
Reynolds 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 someones 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. Bakhtins
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 dialogues 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
Reynolds 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. Rosenhans 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
The Pseudopatients 159
in contrast to the staff Rosenhan notes that it was quite common for
patients to detect sanity in the psuedopatients. Indeed, Rosenhans
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: Youre not crazy. They said. Youre a
journalist, or a professor. Youre checking up on the hospital. Overall, I
believe Rosenhans 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 Rosenhans 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 Rosenhans 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 physicians 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 Rosenhans 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: Youre not crazy!
The power of Rosenhans 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 psuedopatients 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
160 Language For Those Who Have Nothing
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. Bakhtin
61
Of all psuedopatient research the case of William Caudill
62
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
The Pseudopatients 161
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 clinics
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 Caudills death he died suddenly from
cancer in 1972 to discover the profound effect the experiment had for him
personally. In a memorial editorial
66
two former colleagues recall Caudills
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.
Caudills 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 Caudills 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
Caudills paper, I became aware of a quite novel perspective lying dormant
162 Language For Those Who Have Nothing
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, Caudills 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 Caudills
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 clowns fools 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. Bakhtin
70
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 Bakhtins 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:
The Pseudopatients 163
men look ut the world with different eyes, not dimmed by normal, that
is by commonplace ideas and judgements. In folk grotesque, madness is a
guy parody of official reason, of the narrow seriousness of official
Modernitys 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:
truth.
71
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 of a joke. 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
Caudills 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 Caudills
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
164
Language For Those Who Have Nothing
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
didnt 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, thats true.
75
For Bakhtin, the single-toned flavour of administrative discourse has
done much to weaken parodys 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 satires responsibility ends at the
moment it abandons its subject at the material bodily level. It has no brief to
return its subject to a living position. Bakhtin refuses to accept parodys
demise. As a force of the ancient carnival he stresses parodys 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 anothers discourse, toward
someone elses ,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 Morson
77
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
The Pseudopatients 165
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 singled-
sided 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 Luciuss
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, its 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 Caudills 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
Daviss 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
166 Language For Those Who Have Nothing
Caudill refers to an on-going debate among the patients in which they
express their frustrations and doubts about the clinics 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 doctors
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 Bakhtins 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 Hutcheons
83
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
The Pseudopatients 167
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 Hutcheons 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 parodys twofold direction is a distance that permits
the expression of reverence and mockery. Hutcheons 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 Hutcheons 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 parodys orbit, and to test out a
new truth with all the force of parodys 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 Watkins 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:
168 Language For Those Who Have Nothing
Mr Browns imitations of the doctors, nurses and other patients were a
real source of catharsis for the group; and Mr Daviss 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 Caudills
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
We commonly asked patients, 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: Dont tell
them youre well. They wont believe you. Tell them youre sick, but
getting better. Thats 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
its strong parodying component:
The Pseudopatients 169
face. Parodys 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 Caudills transcripts is a characteristic of the
we-experience
89
of the Patient Chronotope. By the we-experience I mean
the gravitational pull of the chronotopes 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 Bakhtins 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. Jasperss voice is ever present in this chronotope. We can
hear the echoes of his voice within the advice given in Felix Posts The
Clinical Assessment of Mental Disorders. Posts 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
170 Language For Those Who Have Nothing
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 Fords 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 Rosenhans 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 1980s 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 of us, 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
The Pseudopatients 171
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 Chronotopes
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 Caudills 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 parodys
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:
172
Language For Those Who Have Nothing
[I]n which they made free associations to each others word salads. They
were smiling and laughing during the course of the game. It was if they
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 psuedopatients
reaction and, indeed, the practitioner patients reactions is their wildly
The Pseudopatients 173
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-mans-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 idealised futer. 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 dont really know them. Indeed
174 Language For Those Who Have Nothing
they dont 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 Rosenhans project could not be of their
timespace. One example is in Helen Rabichow and Mary Phariss
99
hostile
assault where they assume that the staff in Rosenhans 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 Rosenhans 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 Redlichs 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
The Pseudopatients 175
offers a novel position to assess the contrasting relationships to those adrift
in the mid-zone that exists between the two chronotopes. Redlichs 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 no-
mans-land?
Erving Goffman,
101
ever alert to the way performance affects perception,
gives an insightful perspective on no-mans-land as seen from the world of
the Care Chronotope. He writes at length of the betrayal funnel of the pre-
patient 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 Foucaults 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. Goffmans 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 Bartons
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
-took some two years to develop.
176
Language For Those Who Have Nothing
The step-downs I have taken in this landscape suggest an entirely
different range of duration. Encounters and shifts within no-mans-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 slowed-
down 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 Luciuss 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.
The Pseudopatients 177
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.
1
Leff, J.P. and Issacs, A.D., Psychiatric Examination in Clinical Practice, Oxford, Blackwell
2
FTC: pp 111-29
3
Bakhtin draws parallels with the Early Church Fathers practise of purification through
suffering in the pattern of Luciuss 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.1 SO, (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.
( 1990).
10
Millon, T., Reflections on Rosenhans On Being Sane in Insane Places, in Journal of
11
Crown, S., On Being sane in Insane Places: A Comment from England, in Journal of
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)
14
Redlich, F., The Anthropologist as Observer, in The Journal of Nervous and Mental
15
Rockwell, D.A., Some Observations on Living in, in Psychiatry, Vo1.34, (1971) pp214-
16
Redlich, F.,(1973) p3 15.
17
Rosenhan, D.L., The Contextual Nature of Psychiatric Diagnosis, in Journal ofAbnormal
18
Deane, W.N., The Reactions of a Nonpatient to a stay on a Mental Hospital ward, in
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 Professional Psychology, Vol. 1, (1970) pp427-
34.
21
Winkler, R.C., Research into Mental Health Practice Using Pseudopatients, in The
Medical Journal of Australia, Vol. 6I, 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 Professionals
Abnormal Psychology, Vol. 84, NO. 5, pp456-61.
A bnormal Psychology, Vol.84, No.5, pp45 3 -5.
pp632-46.
Disease, Vol.157, NO.4, (1973) pp313-9.
23.
Psychology Vol.84, No.5, (1975) pp462-4.
Psychiatry, Vol. 24, (1961) pp61-8.
View from the Other Side in Professional Psychology, Vol. 3, (1972) pp15 1-4.
178 Language For Those Who Have Nothing
25
ibid: pl52.
26
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) pp214-
23.
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 youre in
a cell thats when things start to get frightening. The second the lights go out, thats it, the
fears start coming.
34
Reynolds, D.K. and Farberow, N.L., p 102.
35
Rockwell, D.A., p219.
Deane, W.N., p62.
37
Meuller, B.S. and Sherman, C.C., p41.
38
Rockwell, D.A., p220.
36
Goldman, A.R., Bohr, R.H. and Steinberg, T.A., p429.
39
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.
43
Rockwell, D.A., p217.
45
Rockwell, D.A. p217.
46
Winkler, R.C., p402.
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,
52
Rockwell, D.A., p222.
53
Deane, W.N., p67.
54
Reynolds, D.K. and Farberow, N.L. p114.
56
SG: p170
57
Chamberlin, J., On our Own: Patient-Controlled Alternatives to the Mental Health System,
58
RAH W: p 10.
Goldman, A.R., Bohr, R.H. and Steinberg, T.A., p429.
Reynolds, D.K. and Farberow, N.L., p104.
42
44
Mueller, B.S. and Sherman, C.C., p40.
47
London, Routledge, (1990) pl85.
55
ibid: pp I 15-6.
London, MIND, (1988) p109.
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.
The Pseudopatients 179
60
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 Caudills method. Redlich, F.C. The Anthropologist
as Observer in The Journal of Nervous and Mental 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,
63
Redlicli, F.C., Forward in Caudill, W., The Psychiatric Hospital as a Smal l Society,
64
ibid: p iv.
65
Caudill, W., The Psychiatric Hospital as a Small Society, Cambridge, MA, Harvard
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.
Vol. 22, ( 1952) pp3 14-34.
Cambridge, MA, Harvard University Press, (1958) p ii.
University Press, (1958).
72
Macdonald. M .. Mystical Bedlam: Madness, Anxiety and Healing in Seventeenth-Century
England, Cambridge, Cambridge University Press, (1 98 1) p1.
73
RAHW: p39.
74
Sass, L.A., Madness arid Modernism: Insanity in the Light of Modern Art, Literature and
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.
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.
Thought, New York, Basic books, (1 992) p112.
and Emerson, C., Evanston, Northwestern University Press, (I 989) pp65-6.
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)
pp2 10-220.
93
Caudill, W., et al., (1 952) p317..
180 Language For Those Who Have Nothing
94
Rosenhan, D.L. (1973) p252.
95
cited in Sass, L.A. p24.
97
ibid; p127.
98
Caudill, W., et al, (1952) p326.
96
Reynolds, D.K. and Farberow, N.L. p138.
99
Rabichow, H.G. and Pharis, M.E., 'Rosenhan was Wrong: The Staff was Lousy', in
Clinical Social Work Journal, Vol.2, No.4, pp27 1-8.
100
Rosenhan, D.L. (1973) p257.
101
Goffman, E., Asylums, Harmondsworth, Pelican, (1961).
102
ibid: p 125.
103
ibid: p 13 1.
104
Foucault, M., Madness and Civilisation,(1961) p13.
105
Goffman, E., p23.
106
Barton, R., Institutional Neurosis, Bristol, John Wright & Sons, (1959) p62.
107
FTC: p84.
108
The quotes in this paragraph are taken from FTC: pp1 15-22.
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. Bakhtin
1
If I am to call myself a polyphonic traveller I must first, reveal more of
my characteristics and second, demonstrate a willingness to apply
polyphonys 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
182 Language For Those Who Have Nothing
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 elses.
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 ones ego ideal to be re-primed or complain that ones
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 dont 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
wasnt 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
The Pseudopatient 183
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 bedded-
clinic-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-and-
out 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 elses 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.
184 Language For Those Who Have Nothing
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 co-
ordinates. 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
projects 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 analysts couch.
Breakfast is cornflakes, bread and margarine, and tea. I emerge
from the boarding house at 9.30am. About an hours 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
dont want to look at people. Keep my head down. Just enough
vision to avoid collisions. Shuts others out. Im 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 dont
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 Im 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
The Pseudopatient 185
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 oclock and that I feel dreadful. Its 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: Ill
call back in a while and then we can have a chat.
186 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 youre ready and Ill 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 dont know what to do
with the spoon. I feel incapable of removing and placing it on the
table. I dont 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 60s 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. 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 youre ready, says Monica. Tell me when youre ready and
Ill 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 Im 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
I just want to retreat.
The Pseudopatient 187
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. Its all right here, she discloses. We
have staff and we have clients. We cant always tell the difference.
Its 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. Ive been here
for four weeks now. If you need to shout then just come and hit this
wall for a while. Itll still be here when youve 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. Im increasingly
troubled in wondering if the nurse knows I am in a role and she is
not, or Im out and shes 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 oclock. This is an
188
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 planed-
off 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 dont 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.
Im sorry. I didnt mean to make you jump. If you have an
appointment at two oclock can I give you a lift?
No. Its all right. I want to walk.
You want to walk?
Yes. Im sorry. I want to walk.
OK. Im 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
The Pseudopatient 189
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 dont mind this or
even the TV. It seems like a way of measuring out the day. I
havent 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 Im 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.
190 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 oclock news comes onto the radio.
Twelve oclock! 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.
Im going to go now and Ill come back on Wednesday.
Are you sure you dont want a lift? He says looking at his
watch.
No. No. Its all right, its all right.
Do they know in the office that youre 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 dont know.
He begins to stand up and I mumble a goodbye and then Im out
in the afternoon rain. What absolute relief.
But it wasnt over. Ten minutes into my walk and I realise Im
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
The Pseudopatient 191
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 co-
ordinates. 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.
192
ADMISSION
Language For Those Who Have Nothing
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 cant or wont 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
The Pseudopatient 193
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 womans 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, its 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
bag
3
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 Hawthorns 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.
194 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 didnt 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 doctors 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:
ThePseudopatient 195
If I stay very still, if I dont 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 self-
aggrandising 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.
196 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.
The Pseudopatient 197
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 Im the night nurse. Im 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 dont
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.
198
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
The Pseudopatient 199
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 Ive discovered it anew. We strike up a
conversation that is innocent and nave. 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 chair-
time. 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
200 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 dont 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. Rachels 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.
The Pseudopatient 201
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 oclock 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
202 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.
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 oclock 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 dont 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 couldnt 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 didnt want to talk to anyone about
the experience.
I look utterly filthy.
DISCUSSION
The two languages frankly and intensely peered into each others faces,
and each became more aware of itself, of its potentialities and
limitations, in the light of the other.
M.M. Bakhtin
4
The Pseudopatient 203
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 after-
shock. 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-for-
me (how others appear to me). These co-ordinates remind us that for
204
Language For Those Who Have Nothing
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 realisms 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-for-
others. 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.
The Pseudopatient 205
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 Ringmasters 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 couldnt 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
206 Language For Those Who Have Nothing
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 Luciuss
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
The Pseudopat ien t 207
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 I-
for-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
208 Language For Those Who Have Nothing
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 Greenslade
6
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 Luciuss 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. 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 Schools 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
This was something I had not done before.
The Pseudopatient 209
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
Hawthorns 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 nave 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 others 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
210 Language For Those Who Have Nothing
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 ones 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?
1
FTC: p 122.
2
Deleuze, G. and Guattari, F., Anti-Oedipus: Capitalism and Schizophrenia, London, Athlone
3
The carrier bag contained an old shirt, a two week-old newspaper, and a pencil. I took no
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.
Press, (1972) p2.
notebook with me preferring to rely on writing up immediately after each stay.
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.
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. Bakhtin
1
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 form-
shaping 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
212
Language For Those Who Have Nothing
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
Bakhtins great exposition of polyphony, the Problems of Dostoevskys
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
Doestovskys 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
Bakhtins 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
Consummation 213
withdrawing into the limited position of declaring polyphonys most stable
properties. For example, Hirschkop
2
uses the concept of polyphony to
describe the separation of the authors voice from their characters, and,
drawing on polyphonys literal meaning argues that it explains the social
stratification of linguistic registers. Morson and Emerson
3
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 Holquist
4
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 multi-
voiced 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 polyphonys 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 participants approach will best determine the potentials of
the encounter.
214
Language For Those Who Have Nothing
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 stepping-
out 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. Bakhtins
emphasis on the birth of polyphony serves two purposes. The first one is
rhetorical. The promise of polyphonys 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 Is 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
Consummation 215
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
Bakhtins 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 icons
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 isnt easy because it
demands a different sense of personal responsibility.
Bakhtins 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 dont 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 Gods 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
216 Language For Those Who Have Nothing
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 polyphonys 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
persons 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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Consummation 217
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 practitioners 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 ones reputation among ones 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 Chronotopes 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 Bauman
12
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. Baumans
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 dont. Every
professional voice bears some resemblance to systems of thinking that
radiate from pulse points on the landscape. A good example of the double-
voiced nature of the professional voice can be seen if we look at the way
Baumans 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
218 Language For Those Who Have Nothing
ingrained has the compartmentalisation of voice and responsibility become
that it is deemed unprofessional the ultimate insult - to question such risk-
free precision.
Coinpartmentalism readily transfers its limitations onto the
administratively tidy formats that are used to organise patients. Karl
Jasperss 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 patients 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 Jasperss 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 Is 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
Consummation 219
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 polyphonys 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
Bakhtins 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 Bakhtins remit. If anything Boris Groys
16
perspective of Bakhtin working as part of an interdependent dualism within
the official regime is the more productive insight. David Shepherd
17
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 Bakhtins
own biography. Bakhtins 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
220 Language For Those Who Have Nothing
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 Bakhtins 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 Bakhtins 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 Holquists 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 Bakhtins
life can be built in a number of ways. Firstly, we can deliver Bakhtin from
Consummation 221
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 Bakhtins 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
Bakhtins 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. Volosinovs 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 Bakhtins 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 everyones 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 Bakhtins 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, Luciuss 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
222 Language For Those Who Have Nothing
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 times 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 Ringmasters 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. Polyphonys 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
Consummation 223
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 Luciuss 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 Luciuss 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
224 Language For Those Who Have Nothing
doubt he got great comfort from Seraphims 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 alibis-
for-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 itself back 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
to the ordered world. And return we must. Because polyphony is so
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
Consummat ion 225
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.
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 patients voice.
Alongside others I too laughed as the Ringmaster dismantled and re-
assembled 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 Bakhtins dialogical words lies the key to polyphonys 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.
And so I end my journey.
1
DiN: p309.
2
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)
3
Morson G.S. and Emerson, C., Mikhail Bakhtin: Creation of a Prosaics, Stanford, Stanford
4
Clark, K, and Holquist, M, Mikhail Bakhtin, Cambridge, MA., Harvard University Press,
5
Stam, R., Subversive Pleasures: Bakhtin, Cultural Criticism and Film, Baltimore, Johns
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
p11.
University Press, (1990) p236.
(1984) p242.
Hopkins University Press, (1989).
Christianity, London, Arkana, (1 996) p276.
226 Language For Those Who Have Nothing
10
TRDB: p285.
11
PDP: pp63-4.
12
Bauman, Z., Postmodern Ethics, Oxford, Blackwell, (1993) p18.
13
Jaspers, K., General Psychopathology, Manchester, Manchester University Press, ( 1963)
14
PDP: p29.
15
The phrase belongs to Terry Eagleton in Walter Benjamin: Towards a Revolutionary
Criticism, London, Verso, (1 981) p149.
16
Groy, B., Nietzsches influence on the non-official culture ofthe 1930s 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, (1 989) p105.
18
Clark. K. and Holquist, M., pp2-3.
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.
p38.
19
ibid: p55.
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
Wednesdays 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)
227
228 Language For Those Who Have Nothing
07Q
08Q
You must all be feeling shell shocked. (2)
Get like you lot. Tired. Anaemic. (1)
09Q
Last years 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)
01 1Q
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
Dont write it down. Unless you really want to. (1)
013Q
Why do some people always ask awkward questions? (1)
014Q
You wouldnt 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. Lets look at exams. You can decide to avoid studying (1). . .
stay up late at night (1). , . drinking caffeine.. . . (1)
01 7Q
. . . . hope the course is not too taxing? (1)
018J
Student asked why dont ants get depressed? Answered that they get
more sex with more ants. (3)
Appendix One 229
019Q
Ive 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 dont 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 dont have to scribble this down. (1)
024Q
Im surprised that 15 of you are here. I feel very privileged. (1)
025J
If I brought a lion in here youd 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
Dont 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
Dont 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 GPs give me a hint in your letters. I cant be a
detective all the time. (1)
230 Language For Those Who Have Nothing
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 its quite a heavy book. (1)
033Q
Why is important to qualify?
034Q
Dont ask are the Martians coming? (2)
035Q
You wont be left alone. [interviewing patients] Dont 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. Cant 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 dont enjoy
what you see. Those that do come back and I will treat you. (2)
040J
This is the best group Ive had. Im 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)
Appendix One 231
043Q
Dont 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
Its 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
Dont scream at me if it isnt happening. (1)
050Q
You are very quiet, very tired as a year. Well do supportive therapy on
you. (3)
051Q
Dont 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)
232 Language For Those Who Have Nothing
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. Ive got some guns
hidden away. (2)
058J
Ill tell you an interesting story. Its 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.
Its 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 dont 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)
Appendix One 233
064Q
Im not stupid. I dont 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 Im 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 didnt
know what was happening. (1)
070J
Two or three sessions of ECT. That usually livens them up. (4)
071Q
Cant get into a psychotics head. Theres no point. I just cant get in. [on
empathy]. (2)
072Q
Very much a sexist remark by a consultant. Shes just a dizzy blonde.
And she was. (1)
073J
Not uncommon to have more than one Jesus Christ on the same ward. (2)
234 Language For Those Who Have Nothing
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 brothers
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 wont 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)
Appendix One 235
COMPETING THEORIES
083J
Psychoanalysis. Where you lie on a couch .. . usually done by a German.
(2)
084J
Mens groups. Sit around and talk about how precious they are. (1)
085Q
Im a psychiatrist. So Im 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
i t . They are supposed to say Id post it. (1)
088J
Nothing will convince this duck that I didnt 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
dont know. Applies to other Parties as well. (1)
092Q
Ill briefly show you Freud in two minutes ( 1) . . . I dont believe any of
this. (2)
093Q
I cant make you sexually attracted to camels. I can never do that. (3)
236
MISCELLANEOUS
Language For Those Who Have Nothing
094J
Clocks! Whoa! Yeah! [hypothetical fetish objects] (3)
095J
Please sir, Ive 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? Lets not tell her shes 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)
0102Q
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 i l l .
( 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), hes 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 Bulmer, M., 146
Addressivity, 34, 38, 44, 50, 87, 88,
Carnival, 4, 6, 17, 66, 76, 93, 99,
Agelasts, 5 1
Agnostico, 14 Canetti, E., 28-29
Air, 81
Care and terror, 74, 77-80
Alibis-for-living, 1 10, 1 14, 1 17, 18 1, Carstairs, G.M., 12
Cartwheel, 90, 101, 102, 117, 125,
Alongside, 16, 49, 97, 109, 118, 120, 128, 132, 134, 139, 153, 158,
Ambivalence, 59, 65, 75, 86, 102, Case history, 50, 67
Caudill, W., 146, 151, 152, 160-72
Anecdote, 48, 49-51 Chamberlain, J., 159
Anti-psychiatry, 11 8, 145 Childress, J.F., 177n.
Apeleius, 143
Chronotope, 10, 16, 2 1-3 1, 98, 1 16,
Ashworth Hospital, 206
119, 143, 144, 201
Assad, M.L., 18n. 95n.
chronotope, care, 14, 23-6, 29,
Authority, 62, 65, 67
49, 77, 91, 110, 134, 153, 169,
173, 175, 205, 218, 223
Bakhtin School, The, 33-34, 43, 208 chronotope, castle, 25
220, 221 chronotope, patient, 23, 27-8,
Barton, R., 175-6
130, 131, 135, 152, 156, 167,
Bateson, G., 78 173, 175
Bauman, Z., 2 17
chronotope, Rabelaisian, 57, 63
Beauchamp, T.L., 177n.
chronotope, threshold, 52, 56, 59
Belle indifference, 27
Belmont Hospital, 1 19
Bergson, H., 58
Berrios, G.E., 85
Bethlem Hospital, 64, 65
Bohr, R.H., 177n.
judgement, 13, 14, 15
Both/and, 17 responsibility, 24, 44
Branthwaite, A., 30 Circus, 63
Brody, F.B., 178n. Conmorbidity, 25
Brooke,D.,77
91, 145, 164
100,138,154,171
206, 223, 224
159, 181 162, 173, 204
105, 150, 173, 175
Clark, K., 18n. 31n. 213, 220
Clarke, B., 64
Clare, A., 18n. 95n.
Clay, J., 121n.
Clinical autonomy, 13
239
240 Language For Those Who Have Nothing
Continuous narcosis, 25 Fourth drama, 164, 166
Contrasts, 63 Freidson, E., 76
Cowper, W., 65 Freud, S., 87, 98-9
Crammer, J.L., 46n.
Crown, S., 177n. Gatekeeper, 182-3,
Cunning, 9, 48, 97, 144, 220, 224 Gaze, 11, 13, 58, 61, 65, 67, 92,
159, 163, 215
DSM IV, 42, 81, 85 Gellers, G., 24
da Vinci, L., 74-5 Genre, 9, 10, 33, 36, 82, 165
Danow, D., 36, 97 Gerber, D.A., 62
Dean, C., 70n. Gibson, D., 3 1n.
Deane, W., 147, 148, 150, 151, 152, Gilmore,H.R., 178n.
156-7 Goffman, E., 145, 175
Deception, 9, 48, 97, 134, 144 Golden Ass, The, 143
Deleuze, G., 208n. Goldman, A.R., 177n.
Dennett, A.S., 63 Gordon, P., 15
Descriptive phenomenology, 13, 6 1 Gramsci, A., 1 13
de Swan, A., 112n. 155-6 Greenslade, L., 208
Dialogism, 3-4, 6, 16, 36, 37, 44, Griffith, T., 79-80
108, 138, 174, 212 Grinker, R.R., 46n.
Dialogue, 10, 11, 14, 17, 18, 29, 33, Grotesque, 62, 66, 69, 138, 150,
36, 44, 50, 88, 91, 108, 132, 136, 153,
150, 207, 210, 213 grotesque, hybrid, 10 1-2, 104
dialogue, inner, 27, 28, 124, 132, grotesque, realism, 8, 60, 61,
168, 169, 202 62, 78, 137, 163, 167
Dingwell, R., 146 Groy, B., 18n. 219
Discovered fellowship, 124, 137-40 Guattari, F., 210n.
Doestoevsky, F., 48, 49, 111, 207,
212, 214 Harrison, P.J., 10
Don Quixote, 222 Hammond, P., 100
Double-bind, 78 Hay, G.G., 144-5
Double-voiced, 2 17-8 Health of the Nation, The, 40- 1
Helman, C., 100
ECT, 66, 124, 131, 188 Hero, 11, 14, 24, 41, 42, 59, 62, 75,
Eagleton, T., 226n. 78, 80, 86, 91, 93, 119, 159, 207
Einstein, A., 22 Heteroglossia, 6
Either/or, 17, 212, 219 Holquist, M., 18n. 31n. 36, 213, 220
Elitism, 13 Hogarth, W., 64
Ely Hospital, 79, 91, 103-4, 107 Historical inversion, 24
Emerson, C., 45n. 112n. 210n. 213 Hughes, S., 129, 130, 131, 133, 152
Entstehongsherd, 37, 38 Humour, practitioner, 47, 48, 52, 53,
Ethics, 48, 146-7
Explanation, 13, 51 Hutcheon, L., 166-7
Etymology, 8 1 Huxley, P., 41
Farberow, N.L., 150, 153, 155, ICD 10, 42
I-for-myself, 203, 207
Faulkener, A., 127 I-for-others, 203, 207
Field, F., 60 Icons, 2 14-6
Fish, F., 12 Ideology, 34, 43
Fleischman, P.R., 146 Initiation, 56-60
Fool, 81, 159 Institutional neurosis, 175
Forest, J., 21 Intonation, 6, 24, 34, 44, 54, 59, 92
Foudraine, J., 136 Intuition, 13, 207, 218, 222
Foucault, M., 37-8, 64, 69, 175 Invisibility, 77, 88, 103, 107, 134,
59, 60, 62, 78
157, 167, 171-2, 173
Index 241
153, 154-5, 156, 181, 219
Mueller, B., 147, 151, 154
Myers, E.D., 30
Napier, R., 80
Nash, W., 47
Neaman, J., 81
Nelson, T.G.A., 54
Neo-classical body, 15, 62, 103, 147,
Nietzsche, F., 6, 13, 37-8
Nightingale, F., 76
Joki, I., 87
Jones, M., 121n.
Obsessive-Compulsive States, 84-5
Jonsson, U., 178n.
Official, 11, 27, 28, 38, 43, 47, 168,
Journey partner, 1 14, 1 18
Jung, C., 149
Orthodoxy, 4-5, 21n. 35, 223
Osmond, H., 120n.
Kaldun, I., 178n. OSullivan, D., 70n.
Kavasilas, N., 5 Other-for-me, 203
Kozhinov, V., 220 Outsidedness, 108, 109
Kraupl-Taylor, F., 12, 84
Palmer, J., 53, 87
Laing, R.D., 78, 107, 113-20, 139 Parody, 11, 28, 87, 181, 207
Langue, 33 Parole, 34
Laughter, 10, 163 Patterson, D., 45n.
alliance, 55 Pharis, M., 174
collective force, 56 Pinel, P., 13, 69
psychic release, 54 Polyphonic traveller, 44, 48, 73, 76,
philosophy, 55 78, 85, 86, 92, 97, 103, 109, 113,
rapport, 54-5,
135, 138, 139, 145, 165, 170, 181,
Leff, J.P., 143
Polyphony, 10, 16-17, 42, 48-9, 51,
Legman, G., 53
Lewis, A,, 12
Posited space, 37
Lodge, D., 162 Possession, 83-5
Lower bodily strata, 6 Post, F., 39, 169
Lucius, 143, 147, 148, 173, 176, 184, Pre-Frontal Lobotomy, 25
Primary Position, 78, 104-5, 109, 115,
Psychiatry, lay concept, 57
Psuedopatient, defined, 144-5
Rabelais, F., 7, 9, 89, 90, 100, 103,
Rabichow, H., 174
Rampton Hospital, 86, 91
Redlich, F., 146, 160-1, 179m. 203
Responsibility, 11 1, 1 17
Reynolds, D., 150, 153, 155, 157, 167,
Ringmaster, 43, 60, 63-9, 73, 83-5,
86, 88, 91, 92, 99, 100, 108, 182,
Issacs, A.D., 143
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, as carnival, 55
jokes, classification, 52,
jokes, targets Nouwen, H.J.M., 226n.
Jokes, 10, 87
153-4, 155, 181, 225
203
scales, 52 218-9, 221-2
97, 103, 109, 120, 143, 144, 212-4
207, 221, 223 Present-State Examination, 193
120, 147, 149, 173, 175, 223
MacDonald, M., 64, 80, 179n.
Maim, H., 120n.
Markides, K.C., 226n.
Masters, A., 71n.
Material Bodily Sphere, 6-8, 9, 60,
Mayer-Gross, W., 12, 84
Millon, T., 177n.
Mockery, 9, 144, 167
Moneiro, A.C., 18n. Relativism, 17
Morgan, H.G., 24, 44
Morrall, P.A., 28
Moth, Z., 2 1 0n.
Mouth, 103-4
76, 89, 99, 105, 165, 203 104
Morson, G.S., 45n. 87, 112n. 164, 213 171-2, 173
205, 222
173
Temporal description, 24, 27, 28, 29
Thaler, O.F., 146
Therapeutic community, 25
Thinking vision, 13, 16, 58
Third, the, 85-8, 89, 93
Rippere, V., 140n.
Rockwell, D., 150-1, 152, 154, 156,
Romantic Primitivism, 119
Romanticism, 98-9, 163 Time,
Rosenhan, D.L., 145-6, 149, 155, 158-
9, 161, 168, 170, 203
Ross, M., 84 great, 82
Rubbernecking, 107 horizontal, 74
Rycroft, C., 112n. imposed, 130
Ryklin, M., 85 small, 82, 83
vertical, 75
Sacks, O., 123, 124 Tuke, S., 13
Sass, L., 163
Saussure, F., 33-4 Uncanny, The, 99
Sayce, L., 127 Understanding, 13
Schneider, K., 12, 84
Scull, A., 24 Unexpected, 17, 103, 105
Secondary Position, 98, 106, 108, 109, Unitary language, 9, 10, 12, 16, 28,
Seraphim of Sarov, 224
Series, 75-7, 89 Unofficial, 27, 28, 43, 134, 136, 144,
Serio-comic, 165 159, 165, 168, 203
Seriousness, 11, 92 Ununderstandable, 14
Serres, M., 7, 94 Utterance, 9, 23, 24, 27, 29, 33, 34,
Shakespeare, W., 80, 214
Shepherd, D., 219
Shepherd, M., 18n. Verstehen, 13, 14, 15, 218,
Sherman, C., 147, 151, 154 Vlissides, D., 18n.
Siegler, M., 120n. Voice, 15, 16, 56, 85, 155, 157, 164,
Slater, W., 84 204, 208, 209
Smail, D., 121n. Volosinov, V.N., 2, 33-4, 116, 221,
Spevack, M., 94n.
Spitzer, M., 12, 38-9, 44 Ware, T, 35, 108
Stallybrass, P., 61 Watt, D., 46n.
Stam, R., 6, 213 Weiner, B., 177n.
Standing, 12-14, 22, 35, 38, 45, 48, Weitz, W., 148-9, 172, 173
57, 60, 90, 100, 154, 155, 173, White, A., 11, 38, 92
Steinberg, T.A., 177n. Whittingham Hospital, 88, 91
Steiner, G., 33, 107 Wilber, K., 106
Step-downs, 17, 47, 98, 103, 120, 176, Willeford, W., 82
177, 208, 224 Williams, R., 140n. 210n.
Stratification, 9, 38 Winkler, R., 151-2
Surplus of seeing, 7, 60-2, 69, 93, Words, 9, 34, 35-6, 43, 60
155, 208, 222-3 words, naming, 88
Surprise, 17, 103, 105 words, sleeping, 80-2
Symington, N., 121n. Wordsworth, W, 2 15
Szasz, T., 80
Zillman, D., 55
Taylor, C., 5
adventure, 144
cyclical, 75, 76, 101, 204
folk belief, 28, 135
120, 155, 173 38-9, 51, 68, 91, 92, 119, 125,
139, 146
36, 48, 50, 145