How does the ‘talking cure’ work for someone who can’t talk?

by Michael

David Small was a kid in need of psychoanalysis. His mother and grandmother raised him – if that is the right phrase – in a household where he was not allowed to have an opinion. A naturally outgoing and expressive child, all that creativity was stamped on. Then, in his mid-teens, he had an operation to remove a lump on his neck. The lump was a tumour that had grown down around his larynx but no one told young David this – when he woke up after the op and found he couldn’t say more than three or four words without getting a sore throat, he thought his mom had got her wish and managed to shut him up for good.

I was listening to David, who is now in his 60s, at a conference about narratives in medicine and healthcare, which started today at King’s College London’s campus at Guy’s Hospital. If the first half-day is anything to go by, the next two days are going to be fantastic. David is not a medical practitioner – he is an artist and he has drawn/written a book about his childhood. It is called Stitches, and I think it is probably amazing. Luckily for him, he found a psychoanalyst who was able to recognise his own upbringing in David’s story and empathise to the point of telling David (who was unable to speak for another 10 years) how he felt, and David was able to agree. David describes his analyst as the “perfect parent”. It was an incredible story in many ways, but I took away a couple of things in particular.

First, from my own experience of counselling (not psychoanalysis, which I would be really interested in trying if it weren’t such an expensive and rare commodity), the construction – or reconstruction – of stories about oneself seems to be at the heart of the process of finding resolution. Perhaps artists and story-tellers are at an advantage here, although I generally got distracted by the arbitrariness of re-telling your story in a positive light when you could just as easily cast it in a negative light – ie the positive tale had no particular authority, which made it rather an empty exercise for me. But what David has done with his book, it seems, is convert what is still a negative experience into something that he can be proud of: I mean, the book is a wonderful achievement which nevertheless incorporates his miserable childhood. It doesn’t rewrite that story as a happy one, but it also doesn’t leave it as a festering sore disconnected with anything positive. He describes the process of making this book as a kind of auto-psychoanalysis, where he was able to stay still, observe himself as he revived these memories, and listen to the crap he was talking from some sort of distance.

The other thing I really enjoyed in David’s talk was his agent’s advice when he was struggling to make progress with the book. Apparently, she told him the only advice she had was what they tell boxers: “Keep your head down and your hands moving.” Perfect advice for a writer, I’d say.

Visualising health

After David’s talk, I went to a breakout session called “Visual clues to health and illness”. A documentary theatre maker, an academic in the French department at King’s College London, and a doctoral student from Texas constituted the speakers and panel, and they were great.

The first (Betsy Campbell) helped me rediscover the obvious fact that theatre is a medium of presence. She went to great pains to explain how she tries to strip all visual information from her scripts for these documentary monologues based on interviews with people who care for others, either professionally or not. At first, I thought this was risible: theatre is visual and so the stripping away of visual fripperies is merely a different type of visual decision. I questioned why she did not play edited audio clips if she wanted to eschew the visual. But then I realised that, whereas theatre used to be inherently visual (as well as other things), that capacity has been largely superseded by the screen, big and small. What theatre does uniquely is to put people and performers in the same physical space together and that has a power. That’s why Campbell needed the text to be performed rather than played, and it may explain why she decided to use actors rather than allow the interviewees to speak for themselves. (I have issues with this type of theatre – like verbatim theatre – where the words of ‘real’ people are spoken by actors in a manner as closely resembling, mimicking, the original speaker’s words and voice: it seems disingenuous to take the voice away from the interviewee (who then receives no recompense or credit), to disembody them, under the guise of giving them a voice.)

The second talk (Anne Elsner) was wonderfully academic and French! It was on the theme of hospitals not really being places where it is in any way pleasant to be, particularly if you are ill. I now want to dig into health architecture, as well as Foucault’s writing about the ‘medical gaze’. In terms of my own story-writing (which I am getting more and more engrossed in through a new project at work), something Elsner said made me prick up my ears: it was about the doctor-patient relationship not being a simple binary but existing and formed by the environment in which it was sustained. I interpreted this in terms of characters in a story, because I am working on a feature with two competitive characters at its core. But of course, it is not the case that one has to be the hero and the other the villain: there are shades here, and both are vulnerable.

The final talk (Erica Fletcher) was rather harrowing in its way, looking at vlogs posted on YouTube by young people with anorexia. Here, these patients (if that is the word) construct and/or reconstruct their own narratives of illness. Of course, these YouTube confessionals have all sorts of potential problems, as well as the potential benefit of allowing the person to assume some sort of control in this situation. There is a problem of ‘performing’ oneself, of being grateful for a ‘relapse’ because it adds another chapter for your followers, or perhaps of pharmaceutical companies one day trying to commercialise the phenomenon by sponsoring such confessionals that pay tribute to their products as successful remedies. But none of these are particularly unique to YouTube or even to the internet. Perhaps in this day and age these potential problems and benefits are clearer to see, however: they can be collated and studied en masse, for example.

I’ll end with one point that came out of the Q&A at the end. Someone asked Elsner what she thought about technology and architecture as regulators of the distance between doctors and patients, and whether they interfered with the potential for compassion. To answer, Elsner described seeing a poster on the hoardings protecting the building work currently going on at Guy’s Hospital. It boasted about being the “tallest hospital building”. Her point was that, if this is what hospitals are boasting about, it suggests somewhere the priorities are not quite right for healthcare.

The tallest hospital building in the world