That way madness lies

To portray something -to make it believable- there has to be at least some understanding by the audience of what is being portrayed. Much in the sense, I suppose, that was suggested in the 1974 paper in The Philosophical Review by the American philosopher Thomas Nagel, asking what it would be like to be a bat. Not so much how it would feel to have the added sense of sonar, or be able to fly in the dark, but more about the consciousness of itself. As Wikipedia explains Nagel’s thinking: ‘an organism has conscious mental states, “if and only if there is something that it is like to be that organism—something it is like for the organism to be itself.”

This is a roundabout way of wondering whether an audience could ever know if an actor is representing something realistically if they cannot imagine what it would be like to be that thing.

Mental illness seems as if it is sufficiently prevalent that most of us would be expected to understand whether or not the author, or the actor, has captured its essence accurately, and yet, for those of us who have not experienced the wide panoply of its manifestations -the majority of us, I suspect- we might be easily mislead. The more gripping or sensational portrayals of illness, might well come to stereotype the lot. To stigmatize the condition.

I was scrolling through the BBC Culture section when I happened upon an article that discusses some of these same issues: http://www.bbc.com/culture/story/20180828-how-cinema-stigmatises-mental-illness

‘… the film industry has generally shown a shaky vision of mental health … It’s not that cinema evades ‘taboo’ themes here; it’s more that it tends to swing wildly from sentimentality to sensationalism.’ To attract an audience -i.e. to make a profit- ‘creative drama is drawn to the complexity and fragility of the mind – but mainstream entertainment still demands a snappy fix. And the definition of ‘insanity’ is inherently problematic.’

I am reminded of the French philosopher Michel Foucault’s book Madness and Civilization -subtitled A History of Insanity in the Age of Reason. He felt that the concept of madness was evolving over time: in the Renaissance, (as a thoughtful summary in Wikipedia puts it) the mad were portrayed in art ‘as possessing a kind of wisdom – a knowledge of the limits of our world – and portrayed in literature as revealing the distinction between what men are and what they pretend to be … but the Renaissance also marked the beginning of an objective description of reason and unreason (as though seen from above) compared with the more intimate medieval descriptions from within society.’

Later, however, ‘in the mid-seventeenth century, the rational response to the mad, who until then had been consigned to society’s margins, was to separate them completely from society by confining them, along with prostitutes, vagrants, blasphemers and the like, in newly created institutions all over Europe.’ (The Great Confinement).

‘For Foucault the modern experience began at the end of the eighteenth century with the creation of places devoted solely to the confinement of the mad under the supervision of medical doctors, and these new institutions were the product of a blending of two motives: the new goal of curing the mad away from their family who could not afford the necessary care at home, and the old purpose of confining undesirables for the protection of society. These distinct purposes were lost sight of, and the institution soon came to be seen as the only place where therapeutic treatment can be administered.’

But, back to the BBC Culture depiction of the role of cinema, ‘our mainstream perceptions of ‘madness’ are still fixated with movie scenes – much more emphatically, in fact, than the novels or memoirs on which they might be based. A classic film like One Flew Over the Cuckoo’s Nest (1975) seals the impression of a soul-destroying psychiatric asylum, where livewire convict RP McMurphy (Jack Nicholson) feigns insanity to escape prison labour – yet is ultimately crushed by the system. The dramatic depiction of patient treatment, particularly its brutal electroconvulsive therapy sequences, had far-reaching impact. In 2011, The Telegraph went so far as to say that the film was responsible for “irreparably tarnishing the image of ECT…’

Unfortunately, unlike many art forms, movies usually require a conclusion, a wrapping up of the story, and a realistic depiction of mental illness may not fit into that convenient format. There may be no black or white: not all characterizations can end either pleasantly or sadly -some are palimpsests, to be sure, but many can reach no definitive conclusions that would satisfy the average moviegoer. Hence the temptation to exaggerate, or at least frighten audiences into an odd manifestation of satisfaction.

The temptation, in other words, to see mental illness as alien, separate -like a creature we could not possibly understand because it is so different. As different, perhaps, as Nagel’s bat. But is it? Or was Foucault really on to something in his analysis of the way ‘madness’ seemed to be viewed in Renaissance literature and art -a view which accepted that at least some of the vagaries, some of the stigmata of mental illness, were merely variations of mental states that any of us could exhibit at times? And indeed, that occasionally intimated unique views on a world from which we might learn some important lessons -a world, though, that we might now discard, or shun as too bizarre. Too frightening. Too… real.

On the other hand, there is a danger of romanticizing the past, of airbrushing its naïveté into soft and reassuring colours; of assuming it was what it was because it had not yet been exposed to the unforgiving exigencies of current knowledge. A time when imagination and reality were sometimes allowed to merge. Encouraged to conflate.

It’s difficult to be certain where present day arts can be placed on this spectrum of understanding mental illness -not the least because it is difficult to know where it should be placed. But, suffice it to say, the more fully the illness is portrayed in all its complexity, the more we might be able to see it as a small, but important part of the tapestry of existence -a fragment of the struggle that marks all our days. And, as for any vicissitude, where there is suffering, we must provide succour and relief, and where there is dissimilarity, offer understanding and acceptance. Tolerance. The soul, says the poet Kahlil Gibran, walks upon all paths. The soul walks not upon a line, neither does it grow like a reed. The soul unfolds itself like a lotus of countless petals.

 

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What is it like to be a…?

I should have known not to answer her question like that. I should have seen the book she was reading; I should have seen how heavy her briefcase was… But I’m getting ahead of myself.

I’m a doctor now -an obstetrician/gynaecologist- but in the beginning I wanted to head in an an entirely different direction: philosophy. And it has remained in the background, nagging at me from time to time -always superficially, of course. My adventures were often confined to a simplistic skimming of the surface of the words, with their all too frequent academic double entendres escaping me completely. But nothing ventured, nothing gained, eh? And I did learn a lot of new phrases that I found I could sometimes slip into my consultations…

Usually I would get away with the occasional philosophical nuance, but I could also be careless at times. One has to be cautious with new patients; there are signs that should be read. For example, it is common sense never to wax philosophical with anyone carrying a heavy book and wearing unstylish, heavy glasses until you know them better. To ignore this maxim is to court embarrassment –or worse, acknowledgment that a boundary has been crossed.

Sandra exhibited all of the danger signs as she sat engrossed in a tome sufficiently heavy to require both knees to support it. A young looking woman with short brown hair and a blue skirt and blouse, she looked as if she were deeply concerned about the meaning of something on the page and as I watched from behind the front desk, she both underlined it and then wrote something in the margin. Even at that distance, I could see she was deadly serious about it. I debated for a moment whether or not to give her additional time to finish her deliberations and see another patient first, but just at that moment she spotted me and smiled.

“Sandra,” I said, walking over to her and wondering how she was going to manage to shake my hand and keep the weighty book safe from the floor.

But she managed it with the skill I would have thought only an older and more experienced scholar could aspire to. And then with a quick, practiced sweep of her other hand, she realigned her glasses further up on her nose, without dropping either the book or her smile in the process.

After that, she, the book and her briefcase followed me to my office and all three of them found a space across from my desk. Once settled, she scanned the room with curious eyes which flitted about like a pair of barn swallows but finally came to rest on a little carved wooden effigy of an African woman holding a baby in her arms.

“What’s it like to be an obstetrician,” she said after examining the woman for a moment.

Although the question seemed simple, it caught me off guard, for some reason and I was suddenly struck with the difficulty of answering something that really had to be experienced to be conveyed, let alone understood. It was almost like trying to describe what its like balancing on a bicycle, or what it would be like to be a police officer walking in a dangerous neighbourhood. It’s a subjective thing that can not accurately be described from the outside.

I’d recently been reading the famous 1974 paper by Thomas Nagel entitled ‘What is it like to be a bat?’ in which he confronts those who would attempt to answer the question by resorting to either physicalism (the idea that everything can be explained by some sort of physical process) or reductionism (by and large that the whole is equal to the sum of its parts): http://organizations.utep.edu/portals/1475/nagel_bat.pdf

I have to admit that I succumbed to the temptation of pretending I understood more of what he wrote than I did. “What is it like to be a bat?” I said -it just slipped out before I could stop it. I suppose that somewhere inside I was thinking I was being clever and that I could then throw out a loose reference to Nagel’s paper –something like his ‘To the extent that I could look and behave like a wasp or a bat without changing my fundamental structure, my experiences would not be anything like the experiences of those animals.’ And so, their experiences being totally alien to me, I would not be able to describe them in words.

But as soon as I said it, I could see by her expression that I had inadvertently crossed a border into the country where she lived. A country where I, perforce, had become a bat. Her bat.

Her eyes immediately hummed with interest. “Fascinating you should ask that,” she said, choosing her words almost as if she were trying to keep them simple –much as we might when speaking to someone from another country. Another culture. “It’s difficult enough to describe what we do to someone in a different field, but an order of magnitude more difficult to describe what it is like to do it…” She smiled disarmingly and then continued. “As Nagel said,” and here she reached down and picked a somewhat lighter book from her briefcase and thumbed through it- ‘Our own experience provides the basic material for our imagination, whose range is therefore limited.’ He picked bats instead of wasps or flounders, he says, ‘because if one travels too far down the phylogenetic tree, people gradually shed their faith that there is experience there at all.’ I suppose he could have chosen dolphins or orcas but… whatever.”

I felt encouraged at her use of ‘whatever’. I thought maybe I could change the subject, but she immediately launched into a description of her position on his argument.

“Me,” she said as if we were sitting in a university lounge discussing the issue over a coffee, “I subscribe to a more intermediate position between reductionism and pure physicalism. I would put myself somewhere in the epiphenomenalist camp.” She looked up from the book and sent her eyes on a brief mission to study my face. The report was evidently not encouraging, so she decided to explain. “Epiphenomenalists posit that mental states are byproducts of physical processes –much as energy and its ability to do work are a product of, say, a steam engine boiling water.”

She carefully replaced the book in its briefcase-vault and stared at me again. Then she shrugged and a mischievous expression gradually conquered the previously academic one. “I think I will rephrase my original question and let you get on with your job. Do you enjoy being an obstetrician?”

“It’s sometimes Hydra-headed,” I said without thinking, and then quickly hid behind the computer screen when I saw her eyes light up once again.