Language for Those Who Have Nothing Mikhail Bakhtin and the Landscape of Psychiatry COGNITION AND LANGUAGE A Series in Psycholinguistics Series Editor: R. W. RIEBER
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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.
AH 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.
CMF 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.
DiN 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.
EN 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.
FM P. M. Medvedev, The Formal Method in Literary Scholarship, trans. Wehrle A. J., Cambridge, MA., Harvard University Press, 1985.
FR V. N. Volosinov, Freudianism: A Marxist Critique, trans. Titunik, I.R., New York, Academic Press, 1976. 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.
MPL V. N. Volosinov, Marxism and the Philosophy of Language, trans. Matejka L. and Titunik I.R., Cambridge, MA., Harvard University Press, 1986.
PDP Mikhail Bakhtin, Problems ofDostoevsky's Poetics, trans. and ed. by Caryl Emerson, Minneapolis, University of Minnesota Press, 1984.
PND 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.
RAHW Mikhail Bakhtin, Rabelais and His World, trans. Iswolsky H., Bloomington, IN., Indiana University Press, 1984.
SG Mikhail Bakhtin, Speech Genres and Other Late Essays, trans. McGee V., ed. Caryl Emerson and Michael Holquist, Austin, University of Texas Press, 1986.
TPA Mikhail Bakhtin, Toward a Philosophy of the Act, trans. Liapunov, V., eds. Michael Holquist and Vadim Liapunov, Austin, University of Texas Press, 1993.
TRDB Mikhail Bakhtin, ‘Towards a Reworking of the Dostoevsky book’, Appendix 11 in Problems ofDostoevsky'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 other’s response. And herein lies the basis of Bakhtin’s 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 psychiatry’s 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 Bakhtin’s 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 one’s 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. Bakhtin’s 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 The Official Landscape of Psychiatry 10 Bakhtin and the Psychiatric Landscape 15
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 Targets 53 Humour and Laughter -The Student Cluster 53 Humour and Laughter as Initiation 56
Humour and Laughter — The Patient Cluster 60 The Display of Madness 62 Summary Discussion 68
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 Dryden’s 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-man’s 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-man’s-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 Nine 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? 216 What Potential is loaned to the Practitioner by Polyphony? 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