Scenes of Madness

A Psychiatrist at the Theatre

Derek Russell Davis

• Publisher: Routledge
• Year: 2002
• Topic: Psychology
• eBook ISBN:
  9781134789009
• Subtopic: Literary Criticism in Drama
• Index: Psychology

Derek Russell Davis argues that mental health professionals working in a hospital or clinic setting can learn much from playwrights about the psychological processes in mental illness. Looking at such diverse characters as Orestes, Hamlet, Lear, Ophelia, Peer Gynt, Oswald Alving and Blanche Dubois, Dr Davis shows how madness in plays is put into the context of the crucial experiences in an individual's history and current relationships, and demonstrates that these stories can be a new and exciting source of insight into mental illness.

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INTRODUCTION

What can we learn from plays about madness? Plays when they portray madness put it into the context of the events and circumstances that have afflicted the person. Also, they identify the significant others in the system of relationships of which he or she is or has been a member. Thus Hamlet’s madness is presented as a consequence of such events as his father’s murder, his uncle’s assumption of the throne, his mother’s remarriage, and what he sees as his rebuff by Ophelia. Among the significant others are his dead father, uncle, mother, Ophelia, Laertes, Polonius and Horatio. The crises in his relationships with them make up the context in which his madness appears. The play, in telling how his madness, feigned or otherwise, develops and recovers, provides a model of madness that is of interest to all those who meet madness in their professional work or their daily lives.

The understanding plays give of madness is all the more vivid because the events are presented dramatically, feelings being evoked as well as intellectual curiosity. For this and other reasons the playgoer may learn as much about madness at the theatre as from any book about psychiatry. But what is learnt is different.

Plays describe scenarios of madness. With few exceptions, they say little or nothing about either the mental mechanisms or the biological factors. Psychoanalysis concerns itself, amongst other things, with mental mechanisms, such as repression, projection and displacement. Psychiatry, at least that in Britain, is dominated by ideas that the essential causes of mental illness lie in disorders in biochemical or metabolic functions, for which a predisposition has been inherited. As a general rule, the explanations it offers reduce the symptoms of illness to what is seen as the essential underlying disorder.

Reductionism has been the prevailing approach in the medicine of the twentieth century, with immense successes to its credit, such as the insulin treatment of diabetes that arose from the discovery of the part played in the symptoms by disorder in the metabolism of carbohydrates. As a consequence of these and other successes, not least those in the control of infections, claims have been made that reductionist explanations are scientific whereas those defining the context are not truly so. Yet to distinguish between what is science and what is not on the basis of the form of the explanation is foolish. What matters is adherence to the rules of science as a discipline, with its three essentials: fidelity to the evidence, rigour in logical formulation and scepticism.

Essays, whether in psychiatry, psychoanalysis or literary criticism, are to be judged without prejudice by the quality of the discipline. Each hypothesis has to be tested by asking such questions as: Does it accommodate the behaviours to be explained? Is it belied by other behaviours? Is there an alternative hypothesis that fits better? The testing may be no more elaborate than that applied in doing a crossword puzzle: do the down words and the across words corroborate one another?

A proper and useful approach towards explaining behaviour, whether mad or sane, is to define its context or, especially, the part it plays in exchanges between one person and another or others within a system of relationships. The context and associated behaviours show whether reddening of the face is the blush of modesty or the flush of anger. Any differences in the underlying biochemistry may have little or no relevance. Again, that the person in Stevie Smith’s poem is ‘not waving but drowning’ is shown by the context that he is ‘much too far out’.¹

Reddening of the face illustrates another point in the development of medicine at the turn of the century and in the approach adopted in this book. This is that behaviour, bodily changes and mental activity tend to be adaptive in that they are components of the organism’s repertoire of response to changes in the environment, the response being the means by which the ‘fixity’ of ‘its interior milieu’ (to use Claude Bernard’s terms²) is maintained. The response is adaptive even if in the particular circumstances it proves to be inappropriate. The common practiceof opening a window when the room is too warm may be maladaptive on a summer’s day when it is warmer outside. Getting angry when frustrated may embarrass attempts to remove the source of the anger.

The principle has been stated in the more general form: ‘The living body is an agency of such sort that each disturbing influence induces by itself the calling forth of compensatory activity to neutralize or repair the disturbance.’³ Increasing the blood flow through the face is thus part of the means by which body temperature is kept constant. The parts played in adaptation by blushing and flushing are less certain.

It is a useful assumption that behaviour is always an attempt at adaptation, however inappropriate it may be in the particular circumstances. Freud made the point in these terms: ‘Any given process originates in an unpleasant state of tension.’ ‘Its ultimate issue coincides with the relaxation of this tension, i.e. with avoidance of pain or with the production of pleasure.’⁴ If that were true, Freud continued, then ‘the vast majority of our psychic processes would necessarily be accompanied by pleasure, or would conduce to it, while the most ordinary experience emphatically contradicts any such conclusion.’ This is the ‘neurotic paradox’ that pervades all discussion of madness.

The madness portrayed in plays is to be seen as attempts to resolve interpersonal problems. Behaviour persisted in although it causes pain and destruction challenges any such theory. Biological theories suppose that madness reflects a morbid process, something that has gone wrong, psychological theories that it reflects a process that is potentially adaptive although ill-suited to the particular circumstances. It is as well to remember that a painful inflammation, such as a boil or an abscess, testifies to the efforts being made by the organism to deal with the invasion of disease-producing micro-organisms.

FIRST STEPS

This book has had a long incubation period. One reason why I chose, just before the start of the Second World War, to embark on a career in psychiatry was the keen expectation, heightened by the recent discovery of phenylketonuria as a cause of one form of mental handicap, that the breakthroughs in medicine just over the horizon would lie in the discovery of the errors ofmetabolism underlying mental illness. As a junior member of the medical staff of a mental hospital I was put each morning to supervise patients while they recovered from comas induced by large doses of insulin, then seen as a promising treatment for schizophrenia. I had the job too of injecting a drug into depressed patients in order to induce epileptic fits; this was the precursor of the electroconvulsive treatment (ECT) still in occasional use.

Listening to patients and hearing about what had happened to them in their lives soon led me to have second thoughts about what breakthroughs were to be worked for. I remember one 18-year-old youth who was receiving the coma treatment. He had been admitted urgently a few days after his father had been taken into another hospital dangerously ill with a coronary thrombosis. He had burst into his mother’s bedroom after she had gone to bed and declared, ‘Le roi est mort! Vive le roi!’. He had then smashed up a cabinet containing his father’s prized collection of china. Alarmed, she had seen his behaviour as having sexual significance. He had probably seen it more as dethroning a tyrannous father. ‘When the king dies’, he said to me, ‘the son takes the throne.’

Having read some of Freud’s work, I knew about ‘displacement’ as a ‘primary process’ by which ‘psychical energy’ is transferred from an intensely charged object or idea to a weakly charged one, in this case from the father to the china cabinet.⁵ Recognising too the relevance of the story of Oedipus, I began to look for manifestations of oedipal conflicts in the other schizophrenic patients passing through our beds, and soon found, as others had done, that incestuous, patricidal and matricidal impulses are rather common. They had often arisen after a critical change in the patient’s relationship with his mother or father, as a result of, for instance, the illness or death of a parent or other member of the family, or the return home of the father after a period of absence; this last was relativly common at the end of the war. In several cases the mother’s remarriage or taking of a lover appeared to play an important part in the development of the illness, as it does in the cases of Orestes and Hamlet.

The descriptions of mental illness then to be found in the textbooks did not satisfy me. Mostly they presented the symptoms, without putting them into a context, as if they were soft neurological signs or as reflecting ‘derailment’ of brain processes—appropriate descriptions when the causes are soughtin disorder in brain functions. Defining the part played by the symptoms in the interaction of one person with another leads to another form of explanation: the two forms are complementary and not mutually exclusive.

Then I began to recognise the similarities of the patients I was treating to such characters as Oswald and Helene Alving (in Ghosts), Ellida and Dr Wangel (in The Lady from the Sea), Blanche Dubois (in A Streetcar Named Desire), King Lear and Orestes. In these my early days in psychiatry I made plans to assemble, one day when I had had time to do the work, a collection of the models of illness to be found in plays.

Sophocles’ King Oedipus provides one model, as Freud has shown, but there are many others. I was later given some encouragement by the reception given to my case-reports of Oswald as a young man suffering from a serious mental illness,⁶ Ellida as depressed and treated suitably by ‘conjoint therapy’,⁷ and Macbeth as caught up in a vicious circle of ambition and despair.⁸ This book implements plans I have had in mind for many years.

THE OEDIPUS LEGEND AS A MODEL

Freud, attaching great importance to the oedipal conflicts in the dynamics of psychoneurosis, although not in major mental illness, of which he had had little experience, pointed out⁹ that ‘psychoneurotics are only distinguished by exhibiting on a magnified scale feelings of love and hatred for their parents which occur less obviously and less intensely in the minds of most children’. ‘The profound and universal power to move of the legend of King Oedipus’ can only be understood if this statement has ‘an equally universal validity’.

In his study of such plays as Hamlet and Rosmersholm he reduced the manifestations of illness to the Oedipus complex. Thus he said of Rebecca West:¹⁰ ‘Everything that happened to her at Rosmersholm was from the very first a consequence of the Oedipus complex—an inevitable replica of her relations with her mother and Dr West.’ Bernard Shaw’s summary of the plot of Rosmersholm, in contrast, written in 1891, does not mention Dr West at all or the incest theme.¹¹

In focusing on Oedipus’ killing of Laius and marriage of Jocasta, Freud’s viewpoint, which is that of the son, leaves outother essentials in the dynamics of the family. He was of course well aware of the fear commonly felt by an older man that he will be dethroned by a younger man or by his son.¹² Had he stood back from the psychoanalyst’s usual position and brought the whole family into his field of vision, his account of the legend would have included Laius’ fear of his son as well as other ingredients of the legend.¹³

He made the discovery of the Oedipus complex through the analysis of his own dreams. Its main importance was that it showed that the roots of unconscious wishes lie in experience in early childhood. It was of lesser importance that it cast a spotlight on just one aspect of Sophocles’ play, leaving others in darkness.

Cursed by Pelops for his kidnapping and homosexual rape of Chrysippus, Laius had been warned by the oracle that he would perish at the hands of his son, and in consequence had refrained from sexual intercourse with Jocasta, except on the one occasion when she had inveigled him into her arms when he was intoxicated, and Oedipus had been conceived. He had instructed Jocasta to destroy the new-born Oedipus. Not obeying him in full, she had him abandoned and exposed on the mountainside, where he was found by a shepherd. Later, on the road to Thebes, Laius had started the fight with Oedipus that had ended in his death. Oedipus too had been warned that he was fated to kill his father, but had not known that Laius was his father. In marrying Jocasta he gained, not only her love, but also his father’s position of power.

The scenario makes a different impression when Oedipus’ killing of Laius is put into the context of these other ingredients. The Oedipus complex is then too simple a formula. An impartial observer would see Laius’ death as the result of the interaction between him and Oedipus in the context of the expectations fostered in each of them by others.

To put this point in other terms, the behaviour of each is explained by reference to the interpersonal as well as the intrapsychic processes affecting them. Some plays, it is true, induce the spectator to identify with a particular character, and to see the events through that character’s eyes.¹⁴ Most plays, in showing how characters interact with one another, are as much concerned with the interpersonal processes as the intrapsychic. How the interpersonal processes reveal the intrapsychic is to be discussed in later chapters.

FAMILY PROCESSES

Breakthroughs in the definition of the metabolic and biochemical errors underlying mental disorder have been achieved, although not quite in the decisive form that was expected fifty years ago, and have led to major advances in treatment. Biological theories have dominated psychiatry therefore during the last two or three decades, and have led to treatments that have done much to alleviate suffering.

One of the reasons why the biological theories have prevailed has lain in the poor development of the psychological theories, and especially those that put the madness into the context of interpersonal, or especially family, processes. There have been some successes, notably those achieved by Theodore Lidz and his colleagues in the Yale Department of Psychiatry in their studies in the 1960s of the ‘intrafamilial environment’ in which schizophrenic patients have grown up.¹⁵ R.D.Laing, amongst others, opened up at about the same time the discussion of the part played by family processes in determining the onset and the symptoms of schizophrenic illnesses.¹⁶

Crucial to the approach in this book is the theory of ‘systems’, introduced into psychotherapy in the 1950s and 1960s, notably by Gregory Bateson and his colleagues at Palo Alto.¹⁷ This theory, derived from cybernetics (a theory based on analogies between the behaviour of man and machine), is concerned with the regulation through communication by two or more persons of each other’s behaviour. Its essence lies in the recognition that when two or more persons are related to—that is, interact with—each other in a system or organisation, the behaviour of one changes only when there are corresponding changes in the behaviour of the other or others.

The studies by the pioneers of the family processes ...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Foreword
• 1 Introduction
• 2 Lessons at the Theatre
• 3 Models of Madness
• 4 The Stories Plays Tell
• 5 Reality and Illusion
• 6 Family Feuds
• 7 Breaking Free from the Past
• 8 Recoveries
• 9 Conclusions
• Notes and sources
• Name index
• Subject index