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‘Recovery Narrative’ as a ‘genre’: some uninvited comments

This academic paper (open access) was published two months ago (when I was rather busy being suspended by the GMC/MPTS, for reasons which remain unclear):

Screenshot_2019-05-15 The Recovery Narrative Politics and Possibilities of a Genre

However I did find time to gently ‘troll’ its lead author about her links to the pharmaceutical industry, and my piece published today attempts to say why I think that might be relevant for the ‘Recovery Narrative’ and ‘genre’ paper, and the so-called ‘Medical Humanities’ more widely.

Screenshot_2019-05-15 from NMacFa angela - Twitter Search

Regular readers of my blog will know that in January I suggested a co-author of the ‘Narrative’ paper, Professor Helen Spandler, was running Asylum Magazine as ‘a self-censoring academic front for establishment psychiatry’.

As a psychiatrist long interested in English Literature, who spent much of 2013-17 drafting proposals for a self-funded MD or PhD, I had come across Angela Woods’ work before. She co-edited a 700-page 2016 book on the ‘Critical Medical Humanities’ but, alas, as with so-called ‘Critical Psychiatry’, the claim to be broadly ‘critical’ is questionable.

If one probes for key words on Google Books (and I have also searched the whole text in the British Library), one gets the impression that ‘Western biomedicine’ (for example) is something undesirable ‘practised historically by white males’ etcetera. But the nature of its undesirability, and how it maintains its ‘hegemony’, is circled around rather than stated.

There is no mention of Ivan Illich’s Medical Nemesis, let alone more recent critics such as Marcia Angell, or David Healy. Yes, Nikolas Rose is referenced, but in my view he is more of an observer and chronicler of biomedicine than a critic of its downsides and excesses.

So Pharma-dominated medicine (including Pharma-psychiatry) has little to fear from this kind of academic ‘output’. And that may be partly a consequence of how most ‘Medical Humanities’ in the UK is funded.

Some more fact-checking is required, but most humanities academics I have talked to over the last 6-7 years have believed it to be overwhelmingly backed by the Wellcome Trust, a 26 billion pound charity which mostly invests on the stock market (excluding tobacco, which might put the #Pharma proportion of the portfolio up a bit from the usual 10% or so of the FT 100 benchmark) but also develops its own vaccines and other pharmaceutical products. (Full disclosure: at one point I explored whether funding for my own MD or PhD might be available from the Trust).

Professor Woods appears to be still part of a major Wellcome project and, interestingly, one of her colleagues at Durham University is a Wellcome-funded anthropologist, with an interest in ‘narrative’, who researches ‘health conspiracy theories. These include beliefs about secret agendas behind vaccination programs, the side effects of medical treatments, and cover-ups by the government or pharmaceutical industry.’

On his University page, professor Tehrani simply makes a much vaguer reference to research on ‘conspiracy theories’ (dropping ‘health’), and does not mention his Wellcome funding. However, scrolling down does show his most recent paper was on ‘antivax attitudes’.

Coming back to the paper on ‘Recovery Narrative’ as a ‘genre’ (the first link in this piece), how might Wellcome’s ‘#Pharma-loaded’-ness be relevant?

Well, the role of the pharmaceutical industry, in promoting biomedicine while marginalising psychosocial understandings and interventions, is completely absent.

Take the semi-fictional ‘Ben…a young person struggling with unusual experiences’ in the second paragraph: ‘When he becomes part of a dynamic mental health charity, his world transforms. He grows in confidence and…he becomes an ambassador for a major national anti-stigma campaign…’.

There is no mention of the degree of funding of the charity by Pharma. Some charities disclose the names of companies, but there is no obligation to do so, and I am not aware of any that itemise exact figures. There is also the issue of industry disclosure, by professionals with formal or informal charity roles, being only voluntary (see No. 4 of my ‘manifesto’).

Ben’s ‘narrative’, as told by the two Wellcome-funded professors and their co-author, continues with his audience getting bored with him, and eventually ‘From hospital, where he has been sectioned, he speaks of a painful ebbing away of his sense of self-worth.’

The suggestion, as I read it, is that ‘Ben’ is more a victim of the media’s general tendency to build up ‘fresh faces’ and later knock them down, rather than of Pharma-psychiatry which has a vested interest in mental health services being poorly funded, so that drugs are used rather than more expensive person-delivered support and psychotherapy.

In the 10,000 words of the whole paper the word ‘drug’ does not appear, and even ‘medication’ only does so twice, with the mildest (if any) of ‘critical’ inflection: ‘The Recovery Narrative can…suggest multiple pathways to recovery (including therapy, medication, familial or peer support, religious counselling, and mental health activism)…’.

I suggest a ‘genre’ for this paper, sadly not a new one: ‘Academic Output Disguising Industry Interests’.

 

 

 

Andrew Solomon’s The Noonday Demon: two decades of #MedHums marketing

(Note for readers new to my blog: although I argue for much greater Pharma-psychiatry regulation and scrutiny, I also oppose pillshaming and anti-diagnosis purism.)

This proposal (lightly edited here) has been accepted, and will be delivered as a twenty minute paper at the July 2019 biennial conference of Symbiosis: A Journal of Transatlantic Literary and Cultural Relations, in Dundee, Scotland. The deadline for proposals has been extended to 25th March.

 

Andrew Solomon’s The Noonday Demon (2001, new edition 2015): an example of US-UK BioPsychiatry marketing through #MedHums (Medical Humanities)

TND

In January 1998 the New Yorker published an autobiographical account of depression by one of its regular writers. Three years later the greatly expanded piece appeared in book form, and it would become arguably the single most impactful Anglo-American work, in any genre or discipline, to promote biopsychiatry in the last two decades.

The Noonday Demon received immense media attention and won over twenty book prizes. I have found only one review which dared to express any significant scepticism, by Joyce Carol Oates, who noted the hypnotic use of ‘mellifluous brand names: Celexa, Xanax, Viagra, Zyprexa, Effexor, Wellbutrin, BuSpar, Depakote, Klonopin, Halcion, Restoril, Zoloft, Paxil et al’.[1]

Andrew Solomon had just published his first (and only) novel, well reviewed in both the UK and the US, when he became depressed. He had a BA from Yale and an MA from Cambridge (England), both in English Literature, and he wove multiple literary quotations and biographical facts through his uplifting account of historical and contemporary neuroscience and psychopharmacology. The depressed and ultimately suicidal Virginia Woolf appears on the second page of the first chapter, and later the reader learns that Solomon was held in high regard as a Woolf scholar by culturally-informed New Yorkers.[2] Shakespeare, Sylvia Plath, and many other canonical writers are employed in the narrative which ends, in the 2015 edition, with an account of the author’s ongoing medications, monitored by both a psychiatrist and a ‘psychopharmacologist’, supplemented by visits to a third specialist, a psychotherapist.[3]

While there is no evidence that Solomon or anyone else ever employed deliberate deception, it is interesting that his father, a businessman, was the CEO of the company which came to license Celexa (under the brand name ‘Cipramil’ it was the UK’s bestselling antidepressant of the mid-2000s) in the US.[4] In 2010 the company, Forest Laboratories, pleaded guilty to criminal overmarketing to children, and was fined $313 million.[5]

I argue that mental health is especially vulnerable to a problematic notion of imbalance between The Two Cultures, potentially leading to an indiscriminate prescription of Humanities in order to counteract overactive Biomedical Science within the mental healthcare body.

As some Humanities scholars have pointed out, quite often ‘humanists can end up privileging medical understandings of health and wellbeing issues’.[6] While not disputing the truth of Andrew Solomon’s account, I explore how that may have occurred in The Noonday Demon and in its transatlantic reception.

 

[1] Joyce Carol Oates, Review of The Noonday Demon, The New York Times 24th June 2001: http://www.nytimes.com/books/01/06/24/reviews/010624.24oatest.html

[2] The Noonday Demon (Scribner, New York, 2015) pp. 87-8

[3] pp. 445-7

[4] https://www.bloomberg.com/news/articles/2002-05-26/a-ceo-and-his-son

[5] https://www.nytimes.com/2010/09/16/health/16drug.html

[6] Maria Vaccarella, Review of Paul Crawford et al., “Health Humanities”, BMJ Medical Humanities Blog (2015) http://blogs.bmj.com/medical-humanities/2015/05/05/the-reading-room-a-review-of-health-humanities/; Anne Whitehead,‎ Angela Woods (Editors) The Edinburgh Companion to the Critical Medical Humanities (Edinburgh University Press, 2016)

 

(Since submitting this abstract I have found a feisty review by Solomon, of James Davies’ Cracked, which defends biopsychiatry while acknowledging some downsides of Pharma’s behaviour. He accuses Davies of ‘pompous psychic Marxism’ and having a ‘smug view of human suffering’.)

Five Psych-Humanities pieces for Mental Health Awareness week 2018: Van Gogh, Dickens (x3) and Jack London

Warning: believers in ‘Down with diagnosis!’ may feel that some of these are ‘disorder-mongering’

Vincent Van Gogh: did he have ADD / ADHD?

An unusual treatment for depression in Bleak House

How Dickens could have improved on the alcoholism and suicide plot in A Tale of Two Cities

Was Scrooge on the autistic spectrum?

The alcoholic Eng Lit professor, and Jack London the creative drinker

 

From atom-splitting to mind-healing

I had to miss a session on The Two Cultures, at last month’s Literature and Science conference in Oxford, because I was myself speaking in a parallel session (see previous entry).

Never having read CP Snow’s original 1959 lecture before, I did so, and was struck by several things which seem to have been filtered out in the huge amount of media and academic commentary it has spawned over the last five decades.

Barely having made a few opening remarks, Snow the promoter of science and scientists puts the boot in to ‘literary intellectuals’ by saying that uncritical admiration for fascist sympathising poets such as WB Yeats, Ezra Pound and Wyndham Lewis was an important cause of Germany’s extermination program in the Second World War.

Well, I happen to have looked at some rather large books on the historical causes of the Holocaust recently, and they did not mention Yeats, Pound, Lewis, or any other poets. That doesn’t necessarily mean that Snow was wrong, of course, but his judgement does not seem to have ‘stood the test of time’.

When he talks about scientists, Snow mostly mentions physicists, such as the atom-splitting Nobel-Prizewinning Rutherford, who he had known personally. Perhaps that just reflects how the wider role of science was discussed in the 1950’s, but it’s interesting that having mentioned the Holocaust and its causes, Snow does not make any point about the very dodgy biological and medical science of Nazi Germany, or the rather less dodgy (and also quite often Nobel-Prizewinning) biomedical science which meant that Britain had little resembling an extermination program itself.

I’m fairly sure that Bad Science, rather than allegedly Bad Anglo-Irish-American Poetry, was more prominently in the minds of those who thought up the Final Solution. To some extent this relies on hindsight, as it was only in the 1980s and 1990s that the British Historian Michael Burleigh more fully outlined the importance of German biomedical eugenics, sterilisation and ‘euthanasia’ of the mentally and physically disabled, as necessary steps which then led to racial genocide.

And as euthanasia (or ‘euthanasia’, as the medically-dominated pressure group Care not Killing might still write it) is very much part of today’s public biomedical discourse, I think that a proper updating of Snow’s Two Cultures argument about ‘literary intellectuals’ would have to properly take account of the general shift of public interest in science, away from atom-splitting and towards …(allegedly) disorder-mongering mental health professionals, perhaps?

My 2012 conference presentations on Benjamin Franklin and ‘Poor Richard’ in Dickens’ fiction

What does this have to do with a psychiatry blog? Look at just about any character in Dickens (especially from the middle and later period) and there are likely to be hints of psychological problems, at least. In these presentations I will be looking at how different aspects of Franklin’s life and works are alluded to in several of Dickens’ works from Martin Chuzzlewit to Little Dorrit.

12th April 2012, Oxford, British Society for Literature and Science annual conference, ‘Benjamin Franklin’s phrenological presence in Bleak House and Little Dorrit’

6th-8th July 2012, Portsmouth, The Other Dickens Conference. ‘Little Dorrit, letters from America, and biographical tracklaying’

10th to 12th July 2012, Edinburgh, Carlyle Conference. ‘Benjamin Franklin as a Carlylean ‘Demigod’: an under-recognised influence on Charles Dickens’s fiction?’

10-12 September 2012, Queen Mary, London, Emotions, Health & Wellbeing Conference. ‘Phrenology, mesmerism and the reptilian personality in Little Dorrit’

Mental health lessons from the 1890’s

 

“Health is the primary duty of life”, according to Algy’s domineering aunt in The Importance of Being Earnest; and such is the unhealthy effect of the aunt and other relatives on his mood, that in order to see them no more than once a week, Algy invents a friend who is in such poor health himself that he requires frequent visits.

Earnest was written and first performed in 1894-5. So, appropriate to the last decade of the nineteenth century, during which logical paradoxes were explored by scholars in mathematics and psychology, Algy’s approach to life is both serious (good mental health is necessary) and non-serious (he rather enjoys the deceptions involved) at the same time.

The play involves the eating of cucumber sandwiches, bread and butter, and muffins. Algy eats so much, in fact, that one wonders how well his ‘imaginary invalid’ strategy really works. Were it not for the romantic ending where he gets engaged to be married and then presumably is happy thereafter, concern about Algy becoming obese due to what we might now call ‘comfort eating’ would be justified.

His friend Jack doesn’t overindulge, perhaps because he’s too busy with his own deception of being the carefree Ernest at weekends, while working hard and being a serious magistrate in the week. Unlike Algy, Jack is lucky enough not to have any domineering relatives to hinder his own dutiful pursuit of health. And he’s happy in the end, as well.

The Charles Dickens Bicentenary

 

Born 200 years ago today, in Portsmouth, what difference did Dickens make, in the nearly-180 years since he started writing fiction and journalism?

Scrooge, Oliver Twist and Fagin are so familiar to us, that it’s perhaps easier to imagine some other writer(s) coming along and filling Dickens’s place on the broad-brush social reform issues, if he had been prematurely taken away by cholera or some other early nineteenth century affliction.

But there are so many other eccentric, strange, mentally unwell and physically disabled characters, who were also very well-known to millions of Dickens’s readers, perhaps even more so after his death, and well into the twentieth century. No other writer of fiction came close to creating awareness of these kinds of human diversity.

Just one example: probably the most severely, clinically, depressed character in Dickens is Bleak House’s Mr Jellyby. He sits with his head “against the wall” and almost never speaks. He’s a failure, and becomes bankrupt.

Illness and death occurs in most Victorian novels, and it is tempting to draw conclusions about the conscious and unconscious motives of the author from who suffers what. I’m uneasy about Dickens’s portrayal of the alcoholic Sydney Carton’s suicidal behaviour in A Tale of Two Cities (1). Dickens himself, in A Christmas Carol, draws attention to the fact that the crippled Tiny Tim “did NOT die”.

And the overwhelming majority of his eccentric and unwell characters do live on, sometimes bizarrely, but never in my view wholly implausibly. Mr Jellyby finds a friend, who talks about himself all the time. Most people would find this friend unbearable, but for some reason Mr Jellyby doesn’t: he listens, and he cheers up. Probably not a complete recovery, but enough to enjoy life again.

 

(1) https://drnmblog.wordpress.com/2011/09/02/a-far-far-better-ending-for-a-tale-of-two-cities/

 

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