Archive | Fiction RSS for this section

‘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’.

 

 

 

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/

 

Back to School

 

I went back to school myself yesterday, starting an MA in Victorian Studies at Birkbeck College, part of the University of London. This follows on from my last blog piece, because quite a few other “Dickens obsessives” have done this course, and some of those teaching on it seem to acknowledge similar afflictions…

Many of my patients, especially those with ADD / ADHD, have thought about picking up where things went wrong in their own education. This may mean going back to do a similar course to the one which they dropped out of; or deciding that was the wrong choice anyway, and studying something quite different.

Although I have dropped out of a couple of courses myself in the past, I’m pretty sure it won’t happen this time. To some extent this is because I believe that I understand my own mild ADD tendencies better (1): my nineteenth-century interest is not an “obsession” in the clinical sense of being related to obsessive-compulsive disorder (OCD), but more of a recurrent ADD / ADHD “hyperfocus”.

 

 

(1) See https://drnmblog.wordpress.com/2010/04/16/how-mentally-healthy-should-mental-health-professionals-be/

A far far better ending for “A Tale of Two Cities”?

 

I am obsessed by the novels of Charles Dickens, although this is a mild-to-moderate rather than a severe obsession, because I have not read any of them more than two or three times. Nor have I properly read more than a small fraction of the dozens of biographies and book-length critical studies published since Dickens’ death in 1870.

The recent riots in London, after the riots in Paris of a few years ago, got me thinking about Dickens’ descriptions of mob violence and mob rule in A Tale of Two Cities. The capture and execution of French aristocrats by the revolutionary Government provides an opportunity for the alcoholic and morally ambiguous lawyer, Sydney Carton, to do something unselfish for once.

I usually disagree with the view that Dickens is an overly sentimental writer of fiction, in the sense of false or distorted emotions being used for propaganda (for example, to promote a non-progressive view of the role of women). But this charge may be correct when it comes to Carton’s fate in the novel: in helping an aristocrat (who he happens to physically resemble) to escape, he deliberately gets himself imprisoned.

On his way to the guillotine, he speaks one of Dickens’ best-known lines: “It is a far far better thing that I do, than I have ever done”.

But is it? Carton’s supposedly noble action can be seen as promoting the idea that alcoholics are inferior beings who cannot change their personalities or behaviour, and do the rest of us a favour when they choose to die. Such was the hybrid of mistaken science and morality which developed in the last decades of the nineteenth century, and went even further in twentieth-century Nazi Germany.

The novel could easily have been written differently, with Carton revealing his true non-aristocratic status, backed up with a hidden physical attribute or some other identifier. Dickens had been the leading English novelist for decades, and had the skill to produce any number of original, plausible and memorable plot-lines based on Carton’s keeping, or at least trying to keep, his head.

 

This post was drafted by 2nd September, and published at DrNMblog.wordpress.com on 6th October

 

The Real Scrooge

 

Why is Scrooge “secret, and self-contained, and solitary as an oyster”: does he have a developmental disorder such as autism?

At the end of A Christmas Carol, “some people laughed to see the alteration in him”. Presumably, such a dramatic change was seen as unlikely. But does that mean we should be so sceptical as to conclude his “self-contained” nature is biologically-based, and therefore unable to be altered?

When he revisits his early adulthood, with the first ghost, he sees himself as having been not at all solitary then: the younger Scrooge happily helps to get ready for Fezziwig’s party, and joins in the dancing, eating and drinking, along with everyone else (1).

It is only a few years later that Scrooge begins to be dominated by his “master-passion” for money. At the same time, he loses interest in ordinary human relationships, although he is arguably right about the hypocritical and (un-) “even-handed dealing of the world”.

So he is not autistic, at least in the sense which would fully explain “old Scrooge”, in terms of a continuous, life-long, pattern of thoughts and behaviour.

Of course, he is only a fictional character; and some might find the description, of his early adulthood, to be as implausible as his later transformation.

At the end, he is still Bob Cratchit’s boss, and although he promises that he will “endeavour to assist your struggling family”, we have to trust Dickens that Scrooge followed up the impulsive gift of a “Turkey…as big as a…boy”, by really being “better than his word”.

 

 

(1) I refer to Dickens’ original 1843 book. All quotations can be found in the text at http://www.gutenberg.org/ebooks/46. Film and television adaptations have often subtly altered the story.

(2) On Christmas Day, Dr Who: A Christmas Carol was broadcast by the BBC. Loosely based on Dickens’ classic, the Scrooge-like central character needs the intervention of the time-travelling Doctor, altering his young adult past to include non-solitary experiences and memories. The dramatic force of the Dr Who story perhaps depends on the fact that film, television and stage adaptations have tended to omit the original content pointed out in my piece. Note added 27th December.

Published at www.DrNM.org.uk on 24th December 2010; transferred to DrNMblog.wordpress.com on 7th October 2011

%d bloggers like this: