Madness and Literature: What Fiction Can Do for the Understanding of Mental Illness

Mental illness has been a favourite topic for authors throughout the history of literature, while psychologists and psychiatrists such as Sigmund Freud and Karl Jaspers have in turn been interested in and influenced by literature. Pioneers within philosophy, psychiatry and literature share the endeavour to explore and explain the human mind and behaviour, including what a society deems as being outside perceived normality.

Using a theoretical approach that is eclectic and transdisciplinary, this volume engages with literature’s multifarious ways of probing minds and bodies in a state of mental ill health. The cases and the theory are in dialogue with a clinical approach, addressing issues and diagnoses such as trauma, psychosis, bipolar disorder, eating disorders, self-harm, hoarding disorder, PTSD and Digital Sexual Assault.

The chapters in Part I address literary representations of madness with a historical awareness, outlining the socio-political potentials of madness literature. Part II investigates how representations of mental illness in literature can offer unique insights into the subjective experience of alternative states of mind. Part III reflects on how literary cases can be applied to help inform mental health education, how they can be used therapeutically and how they are giving credence to new diagnoses. Throughout the book, the contributors consider how the language and discourses of literature—both stylistically and theoretically—can teach us something new about what it means to be mentally unwell.

• Language: English
• Publisher: University of Exeter Press
• Release date: Oct 4, 2022
• ISBN: 9781905816385

Book preview

Madness and Literature

Language, Discourse and Mental Health

Series Editors :

Laura Cariola, Lecturer in Applied Psychology at the University of Edinburgh

Billy Lee, Lecturer in Psychology at the University of Edinburgh

Lisa Mikesell, Associate Professor of Communication at Rutgers University, USA

Michael Birch, Professor of English & Communications at Massachusetts College of Liberal Arts, USA

Mental Health Ontologies

How We Talk About Mental Health, and Why it Matters in the Digital Age

Janna Hastings, 2020

Madness and Literature

What Fiction Can Do for the Understanding of Mental Illness

ed. Lasse R. Gammelgaard, 2022

Eating Disorders in Public Discourse

Using Language-Based Approaches to Explore Media and Lived Experiences

ed. Laura Cariola, 2022

Madness and Literature

What Fiction Can Do for the Understanding of Mental Illness

Edited by

Lasse Raaby Gammelgaard

First published in 2022 by

University of Exeter Press

Reed Hall, Streatham Drive

Exeter EX4 4QR, UK

www.exeterpress.co.uk

Copyright © Lasse Raaby Gammelgaard and the contributors 2022

The right of Lasse Raaby Gammelgaard and the contributors to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

Language, Discourse and Mental Health

The publishers gratefully acknowledge the assistance of the Independent Research Fund Denmark in the publication of this volume.

British Library Cataloguing in Publication Data

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https://doi.org/10.47788/PMMG3806

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Contents

Contibutors

Introduction: Madness and Literature and the Health Humanities

Lasse Raaby Gammelgaard (Aarhus University, Denmark)

Part I: Literary History and Socio-Political Perspectives

  1 Layla and Majnun in Historical and Contemporary Conceptions of Madness in Islamic Psychology

Alan Weber (Weill Cornell Medical College, Qatar)

  2 The Anti-Psychiatry Ethos in Samuel Beckett’s Murphy

Shoshana Benjamin (Ben-Gurion University of the Negev, Israel)

  3 Apartheid’s Garden: Dismantling Madness in J.M. Coetzee’s Life & Times of Michael K

Sebastian C. Galbo (University of Buffalo—SUNY, USA)

  4 Sniffs and Dribblers: Poppy Shakespeare and the Identities of Madness

Clare Allan (novelist)

Part II: Literary Theory and Experiencing Mental Illness

  5 Reading Shattering Minds and Extended Selves in Virginia Woolf’s Mrs Dalloway

Anna Ovaska (Tampere University, Finland)

  6 Spill the Words: Speechlessness and Creativity in the Writing of Janet Frame

Mary Elene Wood (University of Oregon, USA)

  7 Pronominal Shifts and the Confusion of Self with Not-Self

Alice Hervé (writer and independent scholar)

  8 Rethinking Clinical and Critical Perspectives on Psychosis in Kathy Acker’s Writing

Charley Baker (University of Nottingham, UK)

  9 Countering the DSM in Poetry about Bipolar Disorder

Lasse Raaby Gammelgaard (Aarhus University, Denmark)

10 Seeing Feeling: Dissociation and Post-Traumatic Memory in the Graphic Novel Perfect Hair

Penni Russon (University of Technology Sydney)

Part III: Literary Instrumentality and Clinical Psychopathology

11 Writing Therapy, Writing Data: Therapeutic Writing as a Methodological and Ethical Approach in Researching Digital Sexual Assault

Signe Uldbjerg (University of Southern Denmark)

12 A Question of Context: Sites for Cultural Negotiation in Narratives of Manic Depression

Megan Milota (University Medical Center Utrecht, Netherlands)

13 Conscripting Dante: History, Anachronism, and the Uses of Literary Precedents in the ‘New’ Diagnosis of Hoarding Disorder

David Orr (University of Sussex, UK)

14 Opening Up the Discourse of Male Eating Disorders: Personal Experience in German and English Narratives

Heike Bartel (University of Nottingham, UK)

     Afterword

Lasse Raaby Gammelgaard

Index

Contibutors

Clare Allan is a novelist, author of Poppy Shakespeare and of the forthcoming Everything is Full of Dogs. From 2006 to 2018 she wrote a column for The Guardian newspaper on matters relating to mental health, and for many years lectured in novel writing at City, University of London.

Dr Charley Baker is an Associate Professor of Mental Health at the University of Nottingham. She has broad expertise across a range of mental health and illness, with a particular interest in ‘psychosis’, self harm, suicidality, anxiety and obsessive compulsive disorder. She is known internationally for her work in the Health Humanities, particularly in the subfields of literature and mental health, and heavy metal music and self harm. She has worked with a broad range of organizations including the NHS, BBC and different publishers.

Heike Bartel is Professor of German Studies and Health Humanities at the University of Nottingham, UK. Her key publications include Men Writing Eating Disorders: Autobiographical Writing and Illness Experience in English and German Narratives (2020).

Shoshana Benjamin, retired Senior Lecturer from Ben-Gurion University of the Negev and Beit Rivka Teachers’ College, Kfar Chabad, Israel, specializes in the study of cryptic literature. Her publications include ‘On the Distinctiveness of Poetic Language’ (2012) and ‘Is There a Single Right Interpretation for Cryptic Texts?’ (2013).

Sebastian C. Galbo is a PhD student in the English Department at the State University of New York–Buffalo. He holds an MS in information and library science and works as a graduate assistant in the University at Buffalo’s Robert L. Brown History of Medicine Collection. He has been a contributing editor to New York University’s Literature, Arts, & Medicine Database for the last five years. His research interests are interdisciplinary and include the medical humanities, history of medicine and nineteenth-century American literature.

Lasse Raaby Gammelgaard is Associate Professor at the Department of Communication and Culture at Aarhus University, Denmark. He has published articles and book chapters on the depiction of madness in Danish and English literature. He co-directs the research group Health, Media and Narrative at Aarhus University.

Alice Hervé was awarded a Master of Arts in Literature and a PhD in Creative Writing. She writes poetry and prose as well as non-fiction. Post-doctorate, she worked as an Associate Lecturer at Bath Spa University. She has been a full-time writer since 2019.

Megan Milota is an Assistant Professor in Medical Humanities at the University Medical Center Utrecht in the Netherlands. She has published on a variety of topics, including end-of-life conversations in Supportive Care in Cancer (2021) and narrative medicine in the medical school classroom in Medical Teacher (2019) and Medical Education (2021).

David Orr is Senior Lecturer in Social Work at the University of Sussex. He is co-editor of the Palgrave Handbook of Sociocultural Perspectives on Global Mental Health (2017) and sits on the Editorial Board of the international journal Anthropology in Action.

Anna Ovaska is a postdoctoral scholar at Narrare (Centre for Interdisciplinary Narrative Studies) at Tampere University, Finland. Her monograph Shattering Minds: Reading Experiences of Mental Distress in Modernist Finnish Literature (Finnish Literature Society, forthcoming) explores the interaction between a reader and a text in first-person narratives of mental illness.

Penni Russon is a Senior Lecturer in Writing and Publishing at University of Technology Sydney. She is a widely published, critically acclaimed author for young people. Her research concerns the intersections between creative reading and writing and youth mental health.

Signe Uldbjerg is a postdoctoral scholar at the University of Southern Denmark. Other publications on the project presented in this book include ‘Writing victimhood: a methodological manifesto for researching digital sexual assault’ (2021) in Women, Gender and Research, and ‘The rhythms of shame in digital sexual assault’ (2021) in First Monday.

Alan S. Weber has taught the medical and health humanities for the last 15 years at Weill Cornell Medicine–Qatar in Doha, Qatar. He has held previous appointments at Cornell University and Pennsylvania State University.

Mary Elene Wood is a Professor of English at the University of Oregon. She is author of The Writing on the Wall: Women’s Autobiography and the Asylum (1994) and Life Writing and Schizophrenia: Encounters at the Edge of Meaning (2013).

Introduction: Madness and Literature and the Health Humanities

Lasse Raaby Gammelgaard

Although madness (a term that is often reappropriated by scholars working on mental illness in literature) does not exist as ‘an aesthetic category like the grotesque, the sublime or the uncanny’ (Bernaerts, Herman, and Vervaeck 285), the relation of madness to literature has been examined as far back as in Plato’s Ion. Furthermore, psychiatry and the arts have always been reciprocally interested and influenced. They share the endeavour to explain the human mind and human behaviour (cf. Rieger; Oyebode; Baker et al.; Gammelgaard and Boström). To take just two examples, it was the psychologist William James who first coined the term ‘stream of consciousness’ that would become important to the modernist novel, and Karl Jaspers, founder of modern psychiatry, states that we need to study authors like Shakespeare and Dostoevsky to gain a sufficient store of images and symbols and exercise the necessary understanding (Clarke ii).

In spite of the diversity of theory, methodology, literary examples under scrutiny, and national and cultural background of the contributors, this book fits under the umbrella term of the health humanities and literature and medicine. The authors explore mental illness (as a cultural, historical, phenomenological concept) through interpretations of salient literary examples. Hence, literature and psychopathology are put into dialogue by mounting research questions concerning the representation of mental illness in literature. The output of any representation is informed by the affordances and limitations of the chosen medium, and different types of literature are suited to advancing different purposes. This book offers academic engagements with madness literature from a wide diachronic, cultural, and generic spectrum (from medieval Islamic narrative poetry about love and melancholia to contemporary comics about trauma and abuse). The authors engage critically with a range of theories, examining the interplay between medical knowledge of and the humanities’ discourses about mental illness. The individual chapters may hold relevance for a wide group of audiences such as humanities scholars, practitioners (psychologists, doctors, nurses, social workers), patients, their next of kin, and those members of the public who might be interested in the topic.

In Poetic Madness and the Romantic Imagination, Frederick Burwick makes reference to Michel Foucault’s rationality paradox, according to which ‘every attempt to examine irrationality reveals only the rigorous categories of reason’ (Burwick 8–9). However, representing mental illnesses through literature entails conveying fragments, silences, abnormal thinking, strange voices, and more. So the question is whether irrationality might not be examined more freely through imaginative literature than other modes of discourse. The chapters in this volume address how historical and socio-political implications of mental illness have been explored through literature, how literature can help us to better understand the subjectivity of mental illness experiences, and how literature can be instrumentalized—that is, put to use in order to help inform clinical praxis.

This book is titled Madness and Literature: What Fiction Can Do for the Understanding of Mental Illness. At a surface level, two concepts seem to be doubled in the main title and the subtitle—namely, madness/mental illness and literature/fiction. This calls for explanation, if not justification. ‘Madness’ and ‘mental illness’ arguably try to cover roughly the same phenomenon. ‘Madness’, though, is loose, colloquial, and decidedly not politically correct, whereas ‘mental illness’ resonates more with medicalized language use. The term ‘madness’ connotes a distance to a biomedical discourse. It can even—but does not have to—be used to implicate anti-psychiatric sentiments (cf. Rapley, Moncrieff, and Dillon). Individual contributors to this book vary in terms of how critical or endorsing they are of the system in place. ‘Madness’ is used in the title to state that madness literature is not subservient to the discourse of clinical psychiatry in terms of providing insights into mental illness. Additionally, this move places the book in line with academic publications on madness literature that use both ‘madness’ and, for instance, ‘mental illness’ in their titles. More recent publications on the topic, however, often opt for ‘mental illness’ instead. In her entry on ‘Mental Disorder (Illness)’ in the Stanford Encyclopedia of Philosophy, Jennifer Radden states that ‘[f]requently the term "illness in mental illness has been replaced by disorder," apparently without a consistent rationale beyond avoiding explicitly medical language’ (Radden 2019; italics in the original). This seems strange, though, since ‘disorder’ is at least as medicalizing as ‘illness’. In the title for this book, I use both ‘madness’ and ‘mental illness’. This is not to suggest that they are identical or interchangeable, but rather to suggest that they are in reciprocally interdependent dialogue with one another.

The other two terms that operate within the same domain of meaning are ‘literature’ and ‘fiction’. Again, the purpose of this book is not to suggest that they are interchangeable. Literature can be both fictional and non-fictional, and in many of the cases analysed here the lines between the fictional and the non-fictional are blurred or mixed. Fiction, in its turn, is not limited to literature, but exists in movies and television among other things. While this book is limited to literature (with one chapter about comics as a multimodal example, combining text with visual material), it is not limited to strictly speaking fictional literature. However, many of the cases analysed are fictional, and ­‘fiction’ in the title also draws attention to the aim of the book to use fictional (i.e. made-up) stories in a wider theoretical and cultural context.

Critical Tendencies within the Study of Madness and Literature

Madness and literature has been approached via different theoretical perspectives and with various purposes in mind. In this brief overview, I want to demarcate five different approaches to researching interrelations between literature and mental illness: politically oriented studies, psychoanalytic approaches, narrative research, history of medicine, and studies on creativity and madness. Of course, these five cannot always be separated completely from one another, as there are many potential overlaps. The authors of this volume tap into several of the five approaches, often combining one or more of them.

Madness in literature is more often than not in some way tied with political sentiments. Given that mental illness and the treatment of psychiatry patients involve precarious ethical issues such as confinement, forced medication, and other means of coercion and losses of essential liberties, both authors of literature and of academic works are disposed to form an opinion on such aspects. The anti-psychiatry movement emerged because of large-scale anti-humanistic experiments around the treatment of people suffering from mental illness in the twentieth century, such as lobotomy and insulin-induced seizure. The anti-psychiatry movement is associated with the works of Thomas Szasz, R.D. Laing, Michel Foucault, and Erving Goffman (cf. the references for each scholar’s most important work in this regard). In Post-Capitalist Subjectivity in Literature and Anti-Psychiatry from 2021, Hans A. Skott-Myhre revisits Marxist and post-Marxist theories and literary examples to argue that the portrayal of institutions and families therein contains the potential to imagine a new social organization in which subjectivity is freed from capitalist structures.

More recently, a movement labelled ‘mad studies’ has emerged. Peter Beresford, who is a co-editor of The Routledge International Handbook of Mad Studies (2021), states that ‘[mad studies] rejects a bio-medical approach to the domain widely known as mental illness or mental health and substitutes instead a framework of madness’ (Beresford 2020: 1337). Instead of describing human conditions as illnesses or disorders, as is the case within a biomedical framework, mad studies prefers designations like ‘distress’ (Beresford) or ‘misery’ (Rapley, Moncrieff, and Dillon). Depictions of madness as something that goes counter to the established system can be observed in a large number of works of fiction.

Another salient approach to madness and literature is found in psychoanalytic literary criticism. This is inherent in much of Sigmund Freud’s own work, in that he often employed literary examples as illustrations of his psychoanalysis. Perhaps the most prominent example of this is his study The Uncanny, which is partially a reading of E.T.A. Hoffmann’s short story entitled ‘The Sandman’. Shoshana Felman’s book Writing and Madness (first published in French in 1978) mixes anti-psychiatry and psychoanalysis in its conceptual framework. She makes the following claim:

In the nineteenth century, the age of the establishment of the clinician’s power, literature interrogates and challenges this power, gives refuge and expression to what is socially or medically repressed, objectified, unauthorized, denied and silenced. Literature becomes the only recourse for the self-expression and the self-representation of the mad. (Felman 4)

As such, the author takes up the position as anti-psychiatrist. Felman argues that the discourse of the madman can be reclaimed through literature. With reference to Lacanian psychoanalysis, she explains a theory of misprision as a ‘theory of the rhetoric of the unconscious’ (Felman 123; italics in the original), because psychoanalytic defense mechanisms employ ‘all kinds of tropes and figures of speech’ (Felman 122). Psychoanalysis is an approach taken up frequently, but it can take the literary analysis in different directions—which is also acknowledged by Branimir Rieger in the introduction to the anthology Dionysus in Literature: Essays on Literary Madness from 1994, in which he writes that the contributions reflect ‘pluralism in psychological or psychoanalytic criticism’ (Rieger 12; in addition, cf. Wiesenthal).

Psychoanalytic approaches to madness narratives have affinities with some of the approaches from narrative theory. The literary category of the fantastic, proposed by Tzvetan Todorov, is frequently exemplified by texts in which madness plays a role, where readers oscillate between supernatural and naturalistic, scientific explanations of an irrational element in a story. Though not the main focus of this book, madness is a powerful resource for constructing a suspenseful plot in general. In Reading for the Plot, Peter Brooks explicitly sets out to employ psychoanalysis to explain various phenomena in fictional narrative. In chapter four on ‘Freud’s Masterplot: A Model for Narrative’, he employs Freud’s notion of the death drive from Beyond the Pleasure Principle to speculate on narrative desire as a readerly interest. Much of narrative theory’s engagement with madness has to do with understanding authors’ various styles when trying to depict madness. This, of course, has a diachronic dimension. As narrative innovations develop over time, so do authors’ ways of representing mad characters. In Transparent Minds: Narrative Modes for Presenting Consciousness in Fiction, the structuralist narratologist Dorrit Cohn invokes the distinction between showing and telling and states that authors of the nineteenth century ‘choose to tell rather than show those psychic happenings that their characters cannot plausibly verbalize, employing analyses, analogies, and other authorial indirections to penetrate the speechless nether realm’ (Cohn 88). This, however, is not the case with surrealism or the beat writers (for instance William S. Burroughs) of the twentieth century.

Narrative theory has a long-standing interest in mad narrators, who are often analysed as being unreliable. The anthology Les narrateurs fous / Mad Narrators from 2014 (edited by Jaëck et al.) is devoted to the examination of mad narrators in fiction. The contribution by Lars Bernaerts is about the ­rhetoric of first-person narrators who are mad, and in it he makes a useful ­distinction between ‘fou raisonnant’ (referring to clinical-pathological discourse) and ‘fou imaginant’ (referring to the existential-phenomenological delirium) to help navigate the madness discourse. Fou imaginant proposes a more positive and engaging assessment of a narrative delirium. Instead of merely labelling the narrator as mad and hence unreliable in what they narrate, the category of the fou imaginant shows how literature can present the experience of madness as meaningful and mind-expanding, something that Virginia Woolf also advocates in her essay entitled On Being Ill. The narration of madness does not, of course, only take place with first-person narrators. Sometimes fiction uses shifts in the personal pronoun to mark madness. This is the move that William Faulkner employs when Darl goes mad in As I Lay Dying.

Another aspect of narrative theory engaging with madness literature is research into illness narratives. This genre has proliferated since the 1990s, both in terms of publications and of research into the topic. Several advances have been made in the genre of the pathography, where one can distinguish between different illness narratives. For instance, Arthur Frank has described three illness narratives: the restitution narrative, the chaos narrative, and the quest narrative. This raises questions of fiction versus non-fiction, and, in this regard, pathographies about mental illness can challenge autobiography’s ‘preference for the literal and verifiable’ as well as ‘its anxiety about invention’ (Gilmore 129).

Arguably, all approaches to madness and literature have—at least to some extent—a historical dimension. Some publications explicitly mix literary criticism with the history of medicine. And, indeed, publications on the history of medicine frequently use literary examples. This is, for instance, the case with Roy Porter’s book Madness: A Brief History, which provides a concise overview of the history of madness. Two of the seminal books combining madness literature with a history of medicine approach are Lillian Feder’s Madness in Literature from 1980 and Allen Thiher’s Revels in Madness from 1999. Feder’s book draws on literary depictions of madness from ancient Greece to the twentieth century. She foregrounds the discoveries made in fictive texts and how the works reflect contemporary philosophical, medical, social, religious, and political issues. Thiher’s book is in two parts. The first part is on madness from Hippocrates to Hölderlin, whereas the second part is about ‘The Modernity of Madness’ (Thiher 159)—i.e. from madness in romanticism up to the end of the twentieth century. Hence, Thiher’s book has a historically progressing structure, tracing developments in medicine alongside examples taken from literature.

Historical approaches that cite literature in conjunction with medical advances have also led to comparison between symptoms of mental illnesses and textual features from the imaginative world of literature. Two important books that were published just one year apart epitomize this approach—namely Louis A. Sass’s Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought from 1992; and Kay Redfield Jamison’s Touched with Fire: Manic-Depressive Illness and the Artistic Temperament from 1993. Both books examine creativity, more generally, in relation to literature. Jamison’s book is inscribed in a long tradition of seeing relations between what is today labelled ‘bipolar disorder’ and creativity. Touched with Fire, she states, is about ‘manic-depressive illness—a disease of perturbed gaieties, melancholy, and tumultuous temperaments—and its relationship to the artistic temperament and imagination’ (Jamison 2). This line of thought can be dated back at least to Aristotle’s Problemata 30 on the relationship between melancholy and greatness in human beings (and, of course, the topos of furor poeticus dates further back to Plato’s Ion and Phaedrus). However, as Jennifer Radden has argued, it is not unproblematic to align past melancholia with present-day depression—among other reasons, because melancholia covered more symptoms than accounted for in present-day depression (Radden 2003).

Positing relations between creativity and mental illness is often presented as a notion rooted in romanticism, where madness is viewed as individualistic and liberating (cf. Burwick; James; and Whitehead). The view of madness as creative is, in its turn, often associated with manic depression or bipolar disorder. Louis A. Sass challenges this in Madness and Modernism, in which the interpretive strategy ‘is to view the poorly understood schizophrenic-type illnesses in the light of the sensibility and structures of consciousness found in […] the epoch of modernism’ (Sass 1992, 8). He argues that modernist art forms ‘are characterized not so much by unreflectiveness and spontaneity as by acute self-consciousness and self-reference, and by alienation from action and experience—qualities we might refer to as hyperreflexivity’ (Sass 1992, 8). The question of whether creativity is more associated with schizophrenia-type illnesses or affective illnesses (like bipolar disorder and variations thereof) resulted in a special issue of the Creativity Research Journal in 2000–2001, about creativity and the schizophrenia spectrum. In his article in the special issue, Sass states the following:

there seems to be a fairly sharp difference between romantic yearnings for unity with the world, heightened emotional arousal, and intense personal engagement and the modernist preference for isolation, coolness, and detachment. (Sass 2000–2001, 60)

Sass wants to emphasize that schizophrenia is not a dementing illness, but rather one characterized by alienation and hyperreflexivity; that is, whereas the romantic notion of creativity and affective illnesses highlight impulsivity and natural processes, schizophrenic creativity underscores deliberation and rational processes.

Regardless of whether the question of creativity in relation to madness and literature—from a psychological and philosophical perspective—is better aligned with romanticism and aspects of the affective disorders, or with modernism and the schizophrenic spectrum, literary scholars would foreground the creative potential inherent in composing literature about mad characters. Nathalie Jaëck has drawn attention to the notion ‘that mad narrators may provide some writers with an experimental poetical matrix, a metaphor for an ideal literary form, a literary temptation—delirium as the horizon for literature, what Deleuze called "le devenir-fou de la structure"’ (Jaëck 15).

The Health Humanities

The ‘illness’ in mental illness differs from somatic illnesses. To put it crudely, it is easier to give a diagnosis of, say, bone fracture or high blood pressure, while relying on empirical, objective science, than to diagnose someone with schizophrenia, schizoaffective disorder or bipolar disorder. Additionally, the causes of a mental illness rely on different scientific paradigms. From a medical perspective, one may highlight, for instance, neurological implications or genetic dispositions, but it is difficult to disregard social causes such as one’s upbringing and traumatic experiences. Hence, inputs from the human sciences are indispensable. Jennifer Radden describes some intersecting issues related to foundational assumptions behind one’s understanding of mental illness:

Thus, objectivist (or naturalist) accounts, hold that mental disorders are empirically discoverable items that can be provided value-free description, while evaluativist (or normative) analyses deny the possibility of such value-free description […] And finally, the nature of mental disorder will be sought either through a posteriori scientific research based in cognitive science, or through conceptual analysis derived in part or whole from social and cultural norms. (Radden 2019; italics in the original)

Whether one believes mental illness is caused by traumatic experiences, by genetic predisposition or has neurological implications, and to what degree one wants to take these into account, or whether one predominantly wants to look at particular symptoms and clusters of symptoms, there is a shared assumption across the chapters in this volume that literature has the potential to play a role in understanding mental illness, and in negotiating values associated with mental illness.

In his seminal article from 2018 entitled ‘What Does It Mean to Be Mad? Diagnosis, Narrative, Science, and the DSM’, Porter Abbott takes issue with diagnostic typology and advances the following argument:

[Diagnostic typologies are] acts of scientific domestication applied to individuals who nonetheless have, in Savarese’s apt phrase, ‘Irreducible particularity’ (Savarese 2015: 395). This particularity, which not only separates every one of us but lies beyond reach of the finest scientific instruments, is one of the things that make even the most seemingly settled psychiatric classifications necessarily unstable—as witness the constant definitional tinkering in successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). (Abbott 20)

Abbott furthermore argues that the DSM-III from 1980 ‘consolidated a revolution in a field that had been up to then dominated by psychoanalytic theory and practice, and ushered in an era of biomedical dominance’ (Abbott 23). One consequence of this was that the individual case history, which had been ‘the primary instrument in a narrative-based psychology’ would almost cease to be employed as a scientific resource (Abbott 23). Abbott makes reference to a study by Carol Berkenkotter that shows how articles using a case history to support their argument gradually disappeared from contributions to The American Journal of Psychiatry from 1980 to 1991.

However, the subsequent dominance of empirical and biomedical research has created a gap in our human endeavours to grasp what mental illness is, why it exists, and what types of meanings it can maintain. In his article, Abbott contends that madness disables one’s ‘mind-reading capability’, which has an impact on the beholders that ‘registers as an urgent need for a diagnosis that will sufficiently explain the frightening combination of unpredictability and obscurity of intention that signifies madness’ (Abbott 18). Hence, the ascription of madness becomes a necessary ‘placeholder’ when one encounters behaviour that is difficult to understand (Abbott 18). Due to the irreducible particularity of individuals, this placeholder is not sufficient, and the decline of the case history has created a void. Abbott suggests that narrative fiction can to some extent fill that void, since it can ‘let us actually know, without a doubt, what a character is thinking’ (Abbott 24).

The notion that narratives (within fiction as well as non-fiction) can supplement the empirical, positivistic vantage point of medicine resonates well with the field of narrative medicine and more broadly the proliferating interdisciplinary field of the health humanities. For instance, Rita Charon writes that ‘bedrock aspects of narrative practice’ such as ‘temporality, singularity, causality/contingency, intersubjectivity, and ethicality’ are also indispensable narrative features of medicine (Charon 39).

In Health Humanities, a book from 2015 co-written by Paul Crawford, Brian Brown, Charley Baker, Victoria Tischler, and Brian Abrams, the authors contend that ‘in the health humanities, the arts and humanities are used to provide insight into the human condition, and issues such as suffering, personhood and our responsibility to each other’ (Crawford et al. 18). The idea of the health humanities entails a privileged position for literature and the arts in general, for understanding what it means to be in ill health and to be treated by the healthcare system. Health Humanities devotes a significant amount of text space to mental illness in particular, and mental illness does seem to pose a particular challenge for a biomedical discourse (as is evident from the main ideas in Abbott’s article). Crawford et al. write:

Unlike a physical illness, the most extreme test of personal integrity and identity comes in the form of challenges to mental well-being, from depression and anxiety through to psychotic disorders which challenge not only the ‘regular’ experience of emotional health but the sense of secure and reliable perceptions and beliefs. (Crawford et al. 43)

In mental illness representation, for example proprioceptive dysfunctions might be accompanied by disturbances of what phenomenology terms ‘the minimal self’, resulting in an altered sense of bodily demarcation (Brice et al.; Sass, Parnas, and Zahavi). Part of the project of this book is to engage critically with literature that emphasizes and tries to depict the experience of mental illness. It may be that someone experiencing a psychosis makes reference to an object that is actually not there in the world for other people to confirm (say, the dagger in Shakespeare’s Macbeth), and, hence, this could be interpreted as a visual hallucination—yet it truly is something that the person experiencing the psychosis sees. The middle section of this book is thus devoted to the experience of mental illness—for which literary examples can be a great auxiliary resource to aid understanding. Literature has a definite advantage over the case study that one finds in textbooks designed for the education of doctors and healthcare workers specializing in psychiatry, in that literature has more space at its disposal—which enables it to add more context and complexity to psychological descriptions and to conveying human relations. The authors of Health Humanities write the following in this regard:

Whereas the vignette or case study, under the guise of presenting a narrative of a unique experience, portrays a madness experience under a homogenizing diagnostic framework, the literary text instead presents the individual human specificity of cognition, emotion and internality in imaginative and unique form. This in turn reminds us that there is no ‘typical’ experience of madness, despite the homogenizing tendency of the common diagnostic systems. Nosology denies the elements of human agency and autonomy that the literary text epitomizes. (Crawford et al. 44)

Literature can nurture the imagination of both patients and practitioners, so they perceive of individuals ‘outside and beyond the biomedical gaze’ (Crawford et al. 59; italics in the original). However, to get the full output from literature about mental illness, readers must avoid the trap of merely treating it thematically. Literary form or composition is indispensable to the meaning authors create. The authors of this book aim to show how stylistic choices are integral to advancing thematic points and hence, conveying—among other purposes—the thematic meaning of a particular piece of literature. Conversely, the attention to the formal experiments in selected examples of madness literature feed back into the theory employed, causing the authors to modify and rethink central theoretical concepts.

The Structure and Individual Contributions

In spite of multiple theoretical overlaps as well as overlaps in terms of the