Care and Control

Other Mirrors: Language and Representation of Illness.  A Symposium

Saturday 5 August 1995

Introduction - Jean-Paul Martinon
Unpublished Conference Paper
1995 © Jean-Paul Martinon

Good afternoon. Welcome to Sutton House and to the second half of our symposium. I would like to say a quick word on this afternoon session and on the subject overall. During the first half before tea, you will hear Dr. Trevor Turner, Consultant Psychiatrist at Homerton Hospital, Lyn French Art Therapist, and Dr. Francis McKee, Medical Historian. I have asked them to cover three specific subjects in the context of this symposium: Words, Images, and Therapy.

After tea, you will hear two different experiences of the psychiatric institution, one by artist Catherine Yass and one by users who have participated in the exhibition Care and Control. Before that, Mark Cousins, Director of Studies at the Architectural Association and psychoanalyst will provide us with a theoretical framework.

For me, I would like to raise some points around the subject that concerns us today.

A week ago, a patient from the former F Block at Hackney Hospital entered the reception room and sat on the visitor’s chair staring blankly at the floor. After a long silence, I asked this person whether she had come to see the show. She answered no. After another excruciatingly painful silence, I inquired for her name. She muttered a inaudible name. Being foreign and used to this sort of situation, I smiled and asked again. But again, she answered an incomprehensible name. Embarrassed of having failed twice to understand what she had said, I nodded in silence. After another painful moment staring at each other and at the carpet, she left.

While thinking over what had happened, I realised that I had completely failed in communicating with her. That besides our linguistic, cultural, and social differences and her poor medical state, we did not found something to talk about. I wandered then whether this was an example where communication is totally impossible, where even the most basic social skills fail. Beyond linguistic differences were we both so estranged from each other, me apparently sane and her apparently ill that we became Others to each other?

Furthermore, my embarrassment at having failed to engage in a conversation, expressed my desperate desire to communicate, to alleviate the burden imposed by silence, to reassure me and also hopefully her, that she and I weren’t from two planets apart, that we were both alive and on the same planet. This desire to share with someone unknown something in common is in my view the condition for language. Without this desire, this struggle to articulate, which dominates our life, there would be no language, no literature, no art, no life, just plain staring at the carpet. Therefore to communicate satisfies us, reassures us, eases the pain of our own separateness and desire, here becomes the vehicle for expression and creation.

This example, which seems only to refer to an anodyne everyday experience, in fact points towards our own desire to communicate to all, to leave an imponderable mark on specific subjects, to address the masses, to enlarge the number of recipients to our own individual signs. It points towards these innumerable books and art works -to culture overall. Incidentally, this conference on language and representation illustrates perfectly this tiresome desire to understand each other, so as to communicate, to mirror back our own emotions, insecurities or reassuring certainties.

Language therefore appears as mother earth, a reassuring figure to which we address all our sorrows, the one we call when rupture -whether personal (a breakdown) or social (an NHS reform or a hospital move)- occurs. Language, this cathartic purifier, this perfect medication, this saviour, allows the peaceful sleep of the individual and the breathing spells of societies. The reason for this mother-like empowerment of language seems to come from the fact that it establishes itself in between power and act, between understanding and repetition. Without this gap, this abyss provider of power, language would remain a sea of crevices, of emptied out signs, unchanging and dead.

This omnipresent and powerful position of language as we encounter in western societies becomes particularly acute when the subject, the signified, is illness.

The language of illness, more than any other language, rests on the belief of the universality and persistence of language, the belief that words have a certain reality, hide and/or reveal the truth. For example, the closure of Hackney Hospital with its workhouse origins, its obsolete ideological foundations and the opening of a new hospital on Homerton with its sophisticated air-conditioned prefabricated little rooms suggest the persistence of the medical language. Looking at it closely, I feel it suggests more the theoretical indeterminateness of the medical language, of the concept of illness itself. Bastilles are being demolished, Tesco-style hospitals are being built, but schizophrenia persists. In the field of psychiatry, the profession has been moving away from a punitive towards a therapeutic state, from lunatic to service user. Thus, in the twilight of the asylum system and the birth of care in the community, the profession to which these concepts gave birth still endures, constantly seeking to assure us of the validity of the language, therapies and medications used.



This contradiction between the persistence in the belief of the medical language and its theoretical indeterminateness epitomises the two main anxieties around illness: the necessity for speech and the necessity for health. Besides and because of this position the language and subsequently the representation of illness fascinates, intrigues, creates exhibitions, and reunites us all here.

This conference centres on this double anxiety. The necessity for language as a reassuring tool against our own separateness and the necessity for health which comes across through representations of illnesses as reassuring tools against possible or future, real or fantasised illnesses. Out of these two main facets in the problems raised by the subject of illness, I would like here to focus on the representation of illness, and more specifically I would like to map out the various forms of representation of illness.

You probably thought while looking at the exhibition this morning that the term representation of illness is a pretty broad one. It includes figurative, abstract, and conceptual visuals made by artists and service users. Their subject is not illness itself, but the medical subject, a facet of illness. Taken in this very broad sense, the representation of the many facets of illness has a very peculiar history, separate from other iconography such as the representation of love or power. Illness, as you know, and as this exhibition partly demonstrates is represented in various ways.

The first and most common form of representation of illness is found in illustrated histories of medicine. These illustrations appear like unmediated windows into the world of medicine. They testify the evolution of medicine from magic and myth to scientific progress. Their aim is to be a window on reality, to complement the truth observed, to reassure us of our own health.

Illustration 3 seems to say: you can see the truth of my treatment for yourself. This illustration, by indirectly referring to the freakish aspects of the world of illness, insist on our voyeuristic desires, on how we purify ourselves against the evil, against illness. I do not look like her - yet. They also, and perhaps above all, reveal a profound ideological basis. Their distortions, angle poise, and perspective highlight the political and social context in which they were produced, the political agenda behind the medical gaze. They stress the invisible lines of social power in the world of medicine. Ultimately these images perpetuate the laymen’s cultural fantasies about health and the body, the social role of the dyad doctor/patient, illness/cure.

Another form of representation of illness is the scientific iconography. By this I mean the visually dominated sciences of microscopy, bacteriology and, of course, radiology. Technology here seems to force other medical sciences, and particularly psychiatry, to create their own visual epistemology. As the insert shows, psychiatry, drifting away from the old tradition of physiognomic representation of the mentally ill, latches on this relatively new scientific revolution in which the photographic image, the x-ray, -i.e. this seemingly perfect reproduction of reality- speaks for itself, stands on its own without text.

Another form of representation of illness and its more famous sub-category the image produced by the mentally ill. The aim of this kind of image is to show, through an artistic process the internal reality of illness. Here the distortion between representational versus non-representational images becomes unimportant. For such works always stress the universal, unconscious process behind the overt image.

The majority of studies on the work of art made by ill people take, for obvious therapeutic purposes, a medical, psychological or psychiatric angle of analysis. Rare are studies of the art of the mentally ill for example based on a purely aesthetic or historical angle. Illustration 4 is a reproduction of a 1946 poster for an exhibition of work made by psychiatric patients in Paris. Besides the now politically incorrect term “mental patient,” this poster uncannily resembles, by its lack of imagery Rear Window’s invitation to the exhibition Care and Control. What is surprising here is that both advertisements insist on the fact that the exhibition has received the approval of the in-house psychiatrist. This confirms my point that the majority of analysis of the art of the ill has inevitably a medical bias and rarely an objective aesthetic or historical one. This is probably due to the fact that any work of art by the ill interferes and disrupts the traditional dichotomy originally imposed by the illustration of medicine, where sane and healthy artists present sane and healthy viewers with representations of insanity or illness, with cathartic images of the Other, this being-never-to-be. This ancient but persistent medical imposition dictates us to believe that ill individuals can only ill draw or draw the ugly. The association beautiful / health, ugly / ill in any study of the work of art made by ill people is always inherent and seemingly inevitable. All our anxieties around comparing work by service users and professional artists in Care and Control lies on this imposition. If we would not have suffered from this dictatorship, we wouldn’t have called Brian Lundgren wall drawings the work of a service user and you would have just seen an exhibition made by non-professional and professional artists, some of which happen to be ill.

All these various forms of representation of illness (the illustration of histories of medicine, the work of the ill, the scientific iconography...) express our anxieties about illness. And not unlike the medical text, and its tool, the word, the image is a form of control over this anxiety. Even the liberty by which the artists and service users expressed themselves in Care and Control follow the same pattern of control over this anxiety around illness and its representation. This is, you could say, inevitable. Any representation of illness is representation of the anxiety around the illness represented or conceptualised, and the artistic field of creation, whether professional or not, forms the space in which the anxieties are controlled. After all the drawings, installations and sculptures in Care and Control express the constant danger of becoming a user, of falling beyond language, beyond the reassuring speech which holds us together and which brought us all her, outside the Hospital.

Ultimately, all these narratives around representations of illness or of the medical subject deal with power, a power generated by a sense of loss and the illusion of control over this anxiety. The image, the installation or the sculpture focusing on illness or on a medical subject, dominates and translates lived and / or fantasised experiences. They ultimately form the day residues of our fantasies about the world, about ourselves and our own perceptions. Such representations contain the memory of the first and final or last trauma, birth and death, of our initial and final sense of our own separateness.

This I have experienced several times in my life —not only at my birth. In 1992, I was summoned by a friend of my aunt to her deathbed. She had been a concert pianist and an established art therapist in America, and was now dying of cancer. On the day of her death, she raised her frail arm and pointed towards a cassette player. I pressed the play button and while we were both listening to Chopin’s Preludes, a work she had played several times in her life, she slowly drifted away on an invisible river towards an unknown territory. When I now listen to Chopin’s Preludes, I am remembered of her death, but also of my own finitude, my own sense of separateness. These Preludes have now become my representation of death, a contradictory, repressed, healing sound. They are my own illustration of her illness, and of cancer in general. They differ from other experiences, and it is this difference that is unique and impossible to share.

As you probably noticed, I have fallen back on my own feet, to my embarrassment of not having been able to communicate with this patient from the former F Block. So as I lay, quiet on the shore of the river which took my aunt, under the cunning, fascistic and orderly surface of language, I am reminded of Julia Kristeva’s sentence: “While everything else is only literature: the sublime point at which the abject collapses in a burst of beauty overwhelms us and cancels our existence.”