Bodily Chasms and Faux Science Art Projects

The following piece is written by Abi Palmer, writer, critic and visual artist. In it, she discusses the relationship between physical health and scientific experimentation in her most recent project, Alchemy.

ALCHEMY is an interactive poetry experience, responding to a conflict between classical alchemy and early modern science.

In 1661, Robert Boyle, ‘The Founder of Modern Chemistry’ published ‘The Sceptical Chymist’ a text which (amongst other revelations) challenges Aristotle’s theory that the world consists of four fundamental elements – Earth, Air, Fire and Water. Boyle argued that this idea lacked empirical evidence: only through rigorous testing and observation of the interactions between elements could we discover the true chemical properties of the universe. In doing so, he helped to form the basis of the Periodic Table we use today.

Last year, in The Alchemist’s Chest, I created a live performance which responded to Boyle’s challenge, representing the four classical elements through poetic and physical forms. I wanted to provide audience members with the opportunity to play the early modern chemist, experimenting with reactions to different elements: the smell of a lit flame merging with the sound of air, or a murky soil combined with the sensation of running water. By playing the observer, I wanted my listeners to become part of the experiment – which combinations created positive reactions? Did certain variations lead to more emotional responses? Did conflicting elements (Fire vs. Water, for instance) trigger a different response to more harmonious combinations (Fire meeting Air)?

Image Credit: A Palmer

Image Credit: A Palmer

For me this feels like a natural progression of poetry: interesting reactions happen in language when you combine unexpected combinations of words – juxtapositions or harmonies which create connections that might not have existed before. Sometimes, when I hear or read a piece of language that creates a new connection, I can feel tiny little explosions happening in my brain and my body that make me want to cry out, or pull my hair, or jump up and down and wiggle my fingers and shake. Helen Mort often refers to the relationship between language and the body, the “constant dance between the two,” and the impact that her own physical experience of climbing and running have on her own poetry writing process,  on the rhythm of the language, and the ambush of a poem that needs to be written as she travels and moves.

As a person with chronic illness, I too think a lot about the relationship between the body and the writing and reading process. When I was younger and healthier, I worked as a paper delivery girl, waking early each day to cycle from door to door with a heavy stack of newspapers. During that slow, steady cycle, I would often have to halt to pull out a notebook and capture the rhythmic poems and phrases that would repeat themselves over and over again in my mind as the sun came out and the morning grew. I think I learned the most about the craft of poetry writing and editing over those paper-heavy years.

As I grow into an adult, it is harder and harder for my body to move in this way. I can’t cycle anymore, and walking more than a few feet leaves me with a series of painful injuries that keep me awake in the small hours. Even holding a pen and typing comes at a price (tomorrow my arms and fingers will be in agony from writing up this little post). My approach to language has changed. Poetry doesn’t just force itself into my head as often anymore, because I’m rarely moving, and my head is full of pain. And if I am travelling, I’m rarely alone. I’m often accompanied by a carer, or a wheelchair-pusher, or at the very least in a taxi. Writing can no longer be divided from physical sensations – little shots of pain through my wrists or the tight grip of a compression glove around a finger. In her lecture ‘My Body Is a Prison of Pain so I Want to Leave It Like a Mystic But I Also Love It and Want it to Matter Politically,’ Johanna Hedva invited non-disabled people to empathise with this experience by placing a rock in their shoes whilst they listened to her speak.

At this point, it feels like a natural progression to want to include more physical experiences into the poetry process – to inflict physical sensations upon my audience, not just through the rhythmic language which enter one’s body passively, but through external limitations and changes. In my earlier project, Mineralogy Jukebox, I inflicted less comfortable experiences as I read – the sensation of salt melting on one’s tongue (shown following), or sucking upon an incredibly sour sweet. I was amazed by the reception to these ‘micro-immersive’ experiences: not only did strangers listen, but they listened differently. They wanted to feel what I had to say. The Alchemist’s Chest tends to veer to more soothing experiences, but requires a more intense level of physical contact: hands upon hands as soil is rubbed into your palms, or water and ink dripped over your fingers.

S-A-L-T immersive poem. Reproduced with permission from Abi Palmer

S-A-L-T immersive poem. Reproduced with permission from A Palmer

The downside so far has been that each of these projects have relied upon my being strong enough to perform the interactions with my listeners, in a public, physical space. At any one event, the same experiment may be repeated 30-60 times. Think about how hoarse your throat would becomes after reading those same words over and over again. During an outing of The Alchemist at CONTROL ROOM (part of Nottingham’s GameCity festival with Abigail Parry, Jon Stone and Harry Mann), fellow interactive poets talked often about the increased workload and time that an interactive literary experience requires to produce. Whereas on the page or a normal stage, one poem can perform the same function repeatedly, interactive projects contain so many more options which need writing: one poem could have sixteen or six hundred variables. The possibilities are endless, the workload extreme.

In the case of my Alchemy poem, the setup is as a faux-science experiment, but my role in this also creates an unconscious bias: if I am always a factor in the interaction, the results which occur may be manipulated by my own relationship with the listener: I can seduce or repulse them, or anger or alienate them, depending on how our dynamic evolves (if they look sceptical before I begin, do I try harder to win them over in my performance, or do I lose confidence and lack in my delivery?). Although the flaw of presenting poetry project within the framework of a ‘Science’ experiment is consciously absurd, I still felt like it would be worthwhile to increase my own data pool. Why limit the experimental interactions to the number my own body is capable of creating? What happens when other listeners to lead the interactive poetry experience? I created a boxset version of the Alchemy project to overcome both of these obstacles: a physical poetry reading and listening experience for readers and listeners to experiment with and perform for themselves at home.

Image Credit: A Palmer

Image Credit: A Palmer

Early modern scientists in the 17th century made a point of separating themselves from classical philosophy and literature, through the rejection of ‘flowery’ language and ‘rhetorick,’ in favour of empirical experience: physical experiments with repeatable results. In doing so, a vast chasm between literary and ‘scientific’ language and practices unfolded. To me, Alchemy is the poetic equivalent of opening your first childhood chemistry set: a humble attempt at bridging the divide.

Abi’s poem following engages with some of the physiological experience of her condition:

Without Collagen, A Palmer

Image Credit: Abi Palmer

Discourses in global health

Outline the processes through which discourse has concrete outcomes in global health.

To respond to this question is to keep a promise – to qualify and keep in contention the many contextual and linguistic interpretations of the terms that comprise it. ‘Processes’ are perhaps most readily defined as a series of actions or steps taken in order to achieve a particular end, and will here be associated with the case study of the Millennium Development Goals 2000-2015 (MDGs) taking the year 2000 as the main historical departure for this discussion. In the opening remarks to the MDG Summit on 20 September 2010, Secretary-General Ban Ki-moon stated that: ‘there is no global project more worthwhile. […] Let us keep the promise’ (UN, 2010b). This resonates with Jan Neverdeen Pieterse’s concurrent remark that ‘development is the management of a promise – and what if the promise does not deliver?’ (2010, p. 111). This extrapolation of fact into a field of rhetoric and inquiry is perhaps the essence of discourse which, in the social sciences following the formative work of Michel Foucault, is considered to be an institutionalized way of thinking: a socially determined field defining what can be said about a specific topic. Discursive processes can change the content of policy issues and thus open up new options or exclude others. Indeed, one must consider the representativeness of a discourse when considering it as a collection of statements which ‘provide a language for talking about – i.e. a way of representing – a particular kind of knowledge about a topic’ (Hall, 1992). As such, it can be asserted that language is closely connected with power, which in turn impacts the nature of – and feedback on – concrete outcomes. The outcomes are variously considered to be achievement of development goals through statistical analysis or by treating them as benchmarks of progress through coherency of action.

Notwithstanding critique levelled at the MDGs for not focusing on root causes, and an apparent tunnel vision on activity for low-income countries, they represent a case study of an overseas development framework. They will be considered in relation to their successors, the Sustainable Development Goals 2016-2030 (SDGs), which will shed light on the outcomes and progress of the earlier agenda. The SDGs champion an inclusive process that aims to be culturally relevant, fit for purpose and universally applicable to all nations while accounting for differences in engagement and priority. Notably, the temporal lapse between the MDGs and SDGs saw a growing data generation with many global industries capitalizing on the potential for new technology to revolutionise the way that discourse outcomes are assessed and secured. As with discourse, any outcomes must be studied as a sum of parts that interrelate to form goals. So too, they must be examined in context as non-finite, open systems susceptible to the influence of non-discursive factors such as socio-economic determinants. Hall (1992) articulates that discourses ‘go on unfolding, changing shape, as they make sense of new circumstances’ and work towards delivering a promise. Moving from ideology to policy this promise-keeping follows a precedent for ‘the ideological connection between humanitarian concerns, national security, and economic gain, and the sedimentation of these connections into the institutions of state public health and international health’ (King, 2002). The discourses considered following cover discursive, priority-setting, othering, collaborative and empowerment systems and assess the scope and success of the chains by which ideology ‘sediments’ into concrete outcomes.

Discursive discourse, or the practice of producing meaning and power through writing out concrete change, is evidenced in the study of both the MDGs and SDGs. In the UN Millennium Declaration Resolution, the General Assembly remarked that humans should celebrate ‘their diversity of belief, culture and language […]. A culture of peace and dialogue among all civilizations should be actively promoted’ (UN, 2010a). Comparably, discursive formation is defined by Foucault as the functional interaction between several statements, which share ‘a strategy…a common institutional…or political drift or pattern’ (Shortland, 1986). Discourse thus understood transcends the traditional binary drawn between language and practice, so influencing all social practices ‘not as reflections of social reality, but as constitutions of it’ (Gow, 2002). However, this assertion is troubled by the ready reversibility of discourse as noted by Andrea Cornwall: ‘for all the association of Foucault’s work with the totalizing power effects of discourse, […] even the most powerful masters of meanings can never completely secure the capture of language for their own projects. […] It is, after all, in the very ambiguity of development buzzwords that scope exists for enlarging their application to encompass more transformative agendas’ (2010, pp.480-1). This nonfinite quality of discursive discourse suggests that the production of concrete outcomes is not necessarily static and that processes can be diverted or restructured to effect different end-points. Of course, the ‘process’ must not be confused with the ‘product’, but the nature of global health is that situations change, so discursively formed policies that historically produced transformative outcomes must be revisited, reframed and newly implemented. This is the subject of current debate surrounding the neglected tropical disease, leprosy, which the World Health Organization (WHO) has classed as eliminated (defined as a prevalence rate of less than 1 case per 10 000 persons) so politicizing it as of lesser financial and humanitarian priority than other diseases (WHO, 2015). However, its linguistic association with ‘neglected’ suggests an absence of continued material outcomes or reduced prevalence (WHO, 2012).

Meanwhile, the activity of structural power and adjustment through the provision of evidence-based good governance discourse effects outcomes via priority-setting policy, rationality and legislative measures in a frequently self-limiting top-down approach. In addition to identifying the nature and formation of discourse, one must question by whom and how it is controlled in relation to global health. Jeremy Shiffman suggests that: ‘in global health we see structural power at work in the existence of a cadre of individuals […] who offer advice to governments of low-income countries presumed to be in need of their input. And we see productive power at work as they create concepts for thinking about health priority setting’ (Rushton, 2015). In 2012, Fukuda-Parr, et al., remarked that global development goals set priorities in ‘a normative framework based on participatory debate and consultations among governments […] and should be treated as benchmarks for evaluating progress’. This interpretation of the MDGs moves away from the finite perspective of Shiffman, instead adopting a view of the process as discursive and remarkably prescient, foreshadowing the stance taken towards structural power by the SDG agenda. During the post-2015 development summit, conveners acknowledged the ‘essential role of national parliaments through their enactment of legislation and adoption of budgets and their role in ensuring accountability for the effective implementation of our commitments’ (UN, 2015a). In the instance of the MDGs, good governance discourse was used to create outcomes by establishing policy and implementations measured by assessing ‘current achievement levels for each indicator in relation to the defined target’ (Fukuda-Parr, et al., 2012).

Indeed, one initiative under MDG 8 (Develop a Global Partnership for Development) employed good governance discourse to decriminalize HIV positive individuals, drug users and sex workers in the Temeke District of Dar Es Salaam, Tanzania (Millennium Project, 2006). Medecins du Monde’s (MdM) ‘Harm Reduction’ programme was established in 2001 and promotes societal inclusion for these individuals through counselling, care packages, infectious disease screening and weekly group meetings (McCurdy, et. al, 2007). MdM harnessed governance discourse to: reform through decriminalization of national laws or international policies that otherwise marginalise these population groups; promote the concept and activities of harm reduction at both global and local levels; advocate for affordable HIV/AIDS care and educate impacted societies for growth and acceptance through increased funding (Médecins du Monde, 2012). Comparably, Rita Abrahamsen’s Disciplining Democracy (2000) outlines how control over discourse legitimises practice, specifically of Western intervention in Africa through the ‘good governance’ agenda, which is, however, subject to neo-colonial critique. Reacting to this, the World Bank argues for development approaches that are more closely attuned to ‘the traditions, beliefs and structures of its component societies’ (Willott, 2015) so setting up a sustainable method for delivering outcomes.

Financial commitment and security is increasingly included in discourse processes, not least because it is often essential to developing policy and mobilising change. Since the MDGs were conceived, there has been a 58% decrease in global malaria mortality rate [Graph 1] while incidence has fallen by an estimated 37% (UN, 2015b). This progress is largely associated with strengthened political commitment, a tenfold increase in international financing for malaria since 2000, and the availability of widespread diagnostic testing and artemisinin-based combination therapies. These broad and sustained efforts were channeled into ‘policies and measures, at the global level, which correspond to the needs of developing countries and economies in transition’ for a shared future (UN, 2010a).Screen Shot 2016-01-08 at 15.12.40Quoting from the draft release document of the UN summit for the adoption of the post-2015 development agenda, global actors suggest that success in meeting objectives ‘depends on good governance at the international level and on transparency in the financial, monetary and trading systems. We are committed to an open, equitable, rule-based’ process (UN, 2015a).

The Financing for Development work plan that was agreed in 2015 at the Third International Conference held in Addis Ababa, Ethiopia considered mobilisation concerns. As Amina Mohammed commented at a lecture titled ‘The new universal Sustainable Development Goals for 2030: from vision to action’, if the SDGs are to produce concrete outcomes, government expenditure that goes into leveraging the capital economy must be supported by complementary monetary flows. The financing framework of Addis Ababa is, according to Mohammed, operational and ‘doable’ provided smart investments are made that go beyond social corporate responsibility (MattersduMonde, 2015). In the case of the post-2015 development framework, this governance discourse supported by financial processes, gained currency through priority-setting and promoting evidence-based policy. Meanwhile, the legislative authority of The Washington Consensus writes out a prescriptive economic package intended to reform outcomes in the developing world through the united efforts of actors including the World Bank and the International Monetary Fund (Burki and Perry, 1998). However, good governance discourse is not standalone, and many critics have suggested that it does not mobilise the necessary participants but merely guises bureaucratic inertia. Notably, Ursula Read (2009) writes that ‘national legislation may echo the best of the international human rights discourse with its language of freedom, […] however many of those whom it seeks to protect would struggle to understand it, if they were even aware of its existence’. Furthermore, if this form of evidence-based governance is deconstructed its concepts and ideas are seen as being contingent upon historical, linguistic, social and political discourses. ‘In the words of Michel Foucault, these discourses represent an awesome, but oftentimes cryptic, political power that work[s] to incite, reinforce, control, monitor, optimize, and organize the forces under it. Unmasking the hidden politics of evidence-based discourse is paramount’ to seeing products from it (Holmes et al., 2006).

Perhaps one of the least readily acknowledged processes by which global health discourse gains a purchase on development outcomes is through the activity of drawing difference. Hall (1992) identifies the characteristic activities of: drawing hierarchies (such as of the “West and Rest”); marking binaries, and othering or splitting. He suggests that a discourse ‘produces knowledge that shapes perceptions and practice. It is part of the way in which power operates. Therefore, it has consequences for both those who employ it and those who are “subjected” to it’. Historically, the discourse and activity of the West and the Rest has produced outcomes through processes that place countries on a continuum from the most ‘developed’ to the most ‘underdeveloped’ based on pre-defined criteria, which creates a conversation around how countries progress from a state of ‘under-’. Within this lexicon, developing countries are conceptualised in terms of their lack of things the West possess. As Escobar (2012) remarked in 1995: ‘development was – and continues to be for the most part – a top-down, ethnocentric, and technocratic approach, which treated people and cultures as abstract concepts, statistical figures to be moved up and down in charts of “progress”’. While Escobar identifies technocratic concerns surrounding this mode of discourse, in the data revolution that has marked the transition between the MDGs and SDGs, these statistics are crucial to assessing outcomes as well as mobilising donor support. However, these operational binaries establish a series of oppositions between implicitly value-based characteristics such as: development/underdevelopment and tradition/modernity and, as a result, our conceptualisations of what “development” means can be rather narrow, reflecting the dominance of a particular paradigm, which is socially and culturally specific (‘Western’). Similarly, Foucault and Edward Said’s Orientalism have challenged this development discourse which works via ‘othering’ from linguistic levels with pronouns of ‘they’ and ‘us’ (Said, 2003). Such critics highlight the cultural imperialism of this approach which discursively controls power through objectification while also assuming the “West” and “Rest” are cohesive entities (Mosse, 2005).

Although this discussion has sought to avoid subjective qualifications, one discourse that appears to offer the most sustainable outcomes is based on learnings from the MDGs, with discourse surrounding the new development agenda prioritising progressive ideas, collaborative cross-sectoral action and community level engagement. So considered, rather than as finite frames of success, the MDGs are ‘benchmarks of progress, where performance is evaluated by asking whether the pace of progress has improved since the 2000 commitments, and whether it is adequate’ (Fukuda-Parr et al., 2012). By 2015, the narratives surrounding the SDGs acknowledge that: ‘the challenges and commitments identified at these major conferences and summits [referring to the post-2000 development agenda] are interrelated and call for integrated solutions. To address them effectively, a new approach is needed. Sustainable development recognizes that eradicating poverty in all its forms and dimensions, combating inequality within and among countries, preserving the planet, creating sustained, inclusive and sustainable economic growth and fostering social inclusion are linked to each other and are interdependent’ (UN, 2015a).

As was identified through the voices of Foucault, Said and, more recently, Escobar, development discourse has experienced both failures and successes in crystallising words into outcome, but its overall power is inescapable, as Jonathan Crush (1995) noted: ‘this is the power of development: the power to transform old worlds, the power to imagine new ones’. By promoting participation and (community level) empowerment, outcomes have been witnessed, particularly those that prioritise an anthropological viewpoint which underscores much contemporary discourse – ‘an obsession with participation and empowerment’ (Gow, 2002). The SDGs diverge from the MDGs in terms of aspiration, content and scope. A country-level example from the C3 health organisation shows how this collaborative cross-sectoral approach to politics can be highly successful. They established a community engagement programme to help shape and formulate concrete outcomes through actual discourse (i.e. conversation) and donor mobilisation (the Morgan Stanley Banking group) to support disadvantaged children and young mothers in East London (C3Health, 2015). However, even this prescient process of health promotion, with ‘its grounding in science and scientific rationality, […] is not a value-free enterprise. It is enmeshed in power relations, and has profound implications for the self and for the nature of the relationship between selves’ (Petersen, 1996).

If a discourse is a process of understanding subject to power and politics, then its most recent form which prioritises personal accountability, technologisation (‘self management’) and empowerment will continue to gain favour in the global health sphere, as identified in the post-2015 development agenda which supports ‘the implementation of relevant strategies and programmes of action’ (UN, 2015a). There is scope for self-management within a community-based approach to propagate concrete outcomes that are truly polyglot in nature. Read (2009) says ‘there remains a gap between the global discourse on health (one conducted largely in English, the language of power), which is echoed within the corridors and conference rooms of ministries of health […] low-income countries, and the conversations and decisions around health care which take place at community level’. The segue from the MDGs to the SDGs is marked by a question of ownership. No longer is this agenda the elitist property of the government. This time it is owned by the people, with targets of health for all everyone’s very personal business. These goals increasingly apply to developed countries, prioritising inclusivity of all UN member states and accessing hard to reach populations from the goal-setting process onwards. The transformative agenda of the SDGs looks at how to reach those most often neglected while nurturing a growing economy. Mohammed (MattersduMonde, 2015) suggests: ‘we are not subject to the budget; we are the budget’, and as such we must be agents that simultaneously propel concrete action while protecting human rights.

Fifteen years on from the inception of the MDGs, a sustainable approach is seeking to progress both the language and processes of anthropocentric, community-based governance, legislative, and priority-focused discourses to create visible and tangible global change. As Foucault (1982) identifies, ‘what makes the domination of a group, a caste, or a class, together with the resistance and revolts which that domination comes up against, a central phenomenon in the history of societies is that they manifest in a massive and universalizing form, at the level of the whole social body, the locking together of power relations with relations of strategy and the results proceeding from their interaction’. Discourses must recognise their interconnectedness, in which their real applicability sees their differences ‘shade imperceptibly into each other’, across peoples and borders (Hall, 1992). Rather than highlighting otherness, the global health community must unite their voices and processes to create ethical and appropriate impact to ensure that no one is left behind. Aiming to keep this promise, the MDG General Assembly recognize that, ‘in addition to our separate responsibilities to our individual societies, we have a collective responsibility to uphold the principles of human dignity, equality and equity at the global level. As leaders we have a duty therefore to all the world’s people, […] in particular, the children of the world, to whom the future belongs’ (UN, 2010a).

 

 

Image Credit: Possible, Flickr

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Photojournalist of the month: Meredith Hutchinson

Invariably the photojournalists featured on MdM are showcased for their insights into and recording of conflict or post-conflict situations, often framed through language not merely of ‘coverage’, but also of ‘exposé’, ‘triggering visual material’ and ‘shocking scenes’. However, Meredith Hutchinson is remarkable for showcasing lives of the otherwise marginalised or forgotten, identifying their very personal hopes for a brighter future.

Most notably, her collection ‘Vision not Victim‘ is a creative initiative established via the International Rescue Committee that invites teenage girls, who are also Syrian refugees, to explore their dreams and particularly their career aspirations, often for the first time. These visions are captured in the photographs following, which the girls were able to plan and promote to spark conversation and social change in their communities.

The collection describes itself as investing in people, particularly the leaders of the future, and serves as an interesting reminder that social change and shared vision requires renewed focus.

Image Credit: Meredith Hutchinson

Fatima AGE 11. VISION: future surgeon

“In this image, I am examining an x-ray of a patient to see what is causing the pain in her chest. At this point in my life I am a well-respected surgeon in the region. I treat many patients, but the patient I care most about – the one that drove me to be a doctor – is my father, who has lots of medical issues. To be able to help my father, this makes me feel strong, powerful, and capable.”

Image Credit: Meredith Hutchinson

Fatima AGE 10. VISION: future architect

“I’ve always wanted to be an architect. Yet, when I was young people told me that this is not something a woman could achieve, and they encouraged me to pursue a more ‘feminine’ profession. But I dreamt constantly of making beautiful homes for families, and designing buildings that bring people joy. Now that I’ve reached my vision, I hope I am a model for other girls – showing them that you should never give up on your dream – no matter what others say.”

Image Credit: Meredith Hutchinson

Haja AGE 12. VISION: future astronaut

“Ever since we studied the solar system in primary school, I have wanted to be an astronaut. I would imagine myself up in the sky discovering new things. I love being an astronaut because it lets me see the world from a new angle. In this society my path was not easy – many people told me a girl can’t become an astronaut. Now that I have achieved my goals, I would tell young girls with aspirations to not be afraid, to talk to their parents about what they want and why, to always be confident and know where you want to go.”

Image Credit: Meredith Hutchinson

Hiba AGE 9. VISION: future doctor

“I want to help children – I will be a good doctor, because I love children — I would treat children, examine, and give them a cure.”

Image Credit: Meredith Hutchinson

Walaa AGE 14. VISION: future surgeon

“I am smart, curious, and really brave. These qualities have made me a well-respected surgeon and someone people turn to for help. Here, I am prepping a patient for surgery.”

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Fatima AGE 12. VISION: future teacher

“In this image, it is the early morning and I am waiting in my classroom for my students to arrive. I teach younger children to read and write Arabic. I am a very compassionate and kind person, and so a perfect teacher. I am strict, but I go out of my way to gently help those students who are having difficulties.”

Rama AGE 13. VISION: future doctor

Rama AGE 13. VISION: future doctor

“Walking down the street as a young girl in Syria or Jordan, I encountered many people suffering – sick or injured – and I always wanted to have the power and skills to help them. Now, as a great physician in my community, I have that ability. Easing someone’s pain is the most rewarding aspect of my job. To be able to give them relief and make them smile – this is what I love most.”

Image credit (all): Meredith Hutchinson

 

The Psychology of Disasters

Under the auspices of a University College London (UCL) 2016 series of conflict resolution lectures, clinical psychologist and CEO of Psychological Systems and the IASI (Institute for Applied Social Innovation), Dr Richard Sherry shared his understanding of the psychology of disasters and conflict for vulnerable populations. To illustrate his talk he drew heavily on the case of the some 6.5M internally displaced Syrians (IDPs) mainly residing in the regions of Aleppo, Damascus and Homs, many of whom have done so since before 2000.

Two Syrian boys on the outskirts of a temporary camp. Credit: Freedom House, Flickr

Two Syrian boys on the outskirts of a temporary camp. Credit: Freedom House, Flickr

Defining this population as providing the ‘best example of psychological and mental impact of conflict on populations to date’, Sherry proceeded to outline the humanitarian vision of Psychological Systems by delineating the context, the old approach to disaster management and his propositions for shaping current and future methodology. Deserving of coverage, this research area has received renewed interest since the Millennium, not least because, as Sherry suggests, ‘90% of populations who are affected by disasters and conflict are vulnerable’.

The United Nations International Strategy for Disaster Reduction’s (UN/ISDR) definition of a disaster as a serious disruption of the functioning of a community or society, causing widespread ‘human, material, economic and/or environmental losses which exceed the ability of the affected society to cope using its own level of resources’ (2004) captures the collective fragility imposed onto the social body, and in the context of global health often takes the form of a natural catastrophe or armed conflict. By extension, ‘conflict’ can usefully be considered as in opposition to ‘co-operation’ in which a disagreement threatens the interests or priorities of any member involved in the situation.

Image Credit: A Bow-Bertrand

‘What is a disaster?’ [UN/ISDR definition]. Credit: A Bow-Bertrand

What is clear at both linguistic and practical levels is that whether a society immediately identifies as in a state of conflict or co-operation, the balance can rapidly shift from care to coercion, particularly in the case of developing world healthcare provision or areas of heavy external control and investment. The shared re-definition of leadership could change management of conflict situations worldwide inspiring further, meaningful options for the psychologically vulnerable. As in the case of the Syrian IDPs, disasters disrupt healthy, positive systems and coherent emotional experiences and cause further isolation of the already most politically marginalised members of society as evidenced in their government’s in-country censorship and oppression of the rape crisis it seemingly legimitised within the space of war.

Sherry defined a commonly held vision of the aggregated causes and issues that prompt and underpin psychological vulnerability: ‘instability, unintended consequences, vicious circles and error loops, problem of scale, non-robust solutions and redundancy, cross-domain interactions, progressive degradation of human values and quality of life’. This list is far from linear and represents overlapping concerns and exacerbation of standalone causes. Of course, theoretically speaking, prevention of conflict is far preferable to trying to reach conflict resolution, especially in circumstances where multiple causes play into the psychological vulnerability of a situation and population.

If we are to be generous, Sherry’s discussion was idealistic: to be factual, it was misguided. He seemed to overlook the entrenched and on-going nature of many conflicts, focusing less on the difficulties of socially re-integrating Syrian refugee children into post-conflict situations and more on their psychological immaturity. The mental health reality of this case is, of course, overwhelming but it is unsurprising that the risk of psychological vulnerability is greater for those who have a high perceived risk to life.

Sherry continued with a discussion of methods of psychological vulnerability management that have emerged since the Millennium. Appropriately, given his soapbox at UCL, he referred to The Sphere Project (2011) whose partners include UCL and the Wellcome Trust and judiciously remarked that its predominant focus on diagnosis and complex feedback loops are procedures that do not really address the root psychological problems or causes in the case of this Syrian population, and may actually cause dysfunctionality. It is a double-bind that many of these social systems require dysfunctionality in order to initiate change.

Credit: Sphere Project

Credit: Sphere Project

On-going, it will be most important to ensure the leadership approach adopts a positive framework that shifts and facilitates sustainable change from shame to confidence, mistrust to trust, illness to health, freezing to action, distress to joy, disconnection to connection, disenfranchisement to leadership and healing. This management will require integration, resilience, scalability, dynamic change and sustainability, areas commonly highlighted in disaster discourse of this kind, not least in the ICDS model of Psychological Systems (shown below).

IDCS model. Credit: Psychological Systems, Dr R. Sherry

ICDS model. Credit: Psychological Systems, Dr R. Sherry

Sherry’s work with IASI orientates around resistance, which has surprisingly close connections with resiliance. Indeed, their ‘Nurturing Compassion and Tenderness‘ project explores the effects of sowing and growing plants on the process of overcoming trauma. Sherry illustrated how compassion and tenderness nurtured in the process of growing plants could help communities to redevelop their self-identity through reviving basic inter-human and human-environment bonding relationships. This project aims to encourage a habit of observing firstly the ‘process’ in nature, next the effects of humans on the environment, and identification and use of appropriate resources to make optimal use of available land.

This all sounds entirely plausible and it comes as no surprise that such green fingered endeavours can be therapeutic and of particular benefit to disaster struck populations such as the Syrian IDPs. Fundamentally, this is as simple as becoming figuratively ‘grounded’, because, someone who is in trauma is ‘ungrounded’, or as Sherry suggests ‘their bodies are somatising, you need to help them find ways to be safe and sound’. Where Sherry’s project becomes uprooted is in its (in)feasibility.

Certainly, the bonding relationships it hopes to encourage between person and nature can offer transferable skills that promote social cohesion at leadership and personal levels both internally and externally, simultaneously working on an individual’s psychology and their physical environment. However, ‘Nurturing Compassion and Tenderness’ professes to be a new, instructive approach that will also teach people how to adopt and sustain a healthy lifestyle. Indeed, it is being turned into a mobile app used on the ground by people in conflict situations with the USP ‘to try and teach them how to act with compassion, both towards themselves and others’. Even verbatim, there is much to take issue with in this self-claimed new approach.

The project includes specifically devised growing manuals. Credit: IASI

The project includes specifically devised growing manuals. Credit: IASI

Primarily, the lexicon of edification is an uneasy pitch to this population, seemingly exposing itself as a Western, privileged application of a lifestyle methodology that these displaced persons have, in fact, habitually used for productivity and sustenance over many years. After all, in the case of Syria, until the late 1970s, agriculture was the primary economic activity, and its population are still widely versed in the practice of the land’s potential growth and yield cycles. Secondly, with no present in-situ déroulement of this theory in practice, one cannot help but think the recipients or proposed users of this service will bring to it some potentially productive, but currently overlooked, attitudes towards sowing and nurturing plants as one of basic life survival rather than the project’s singular vision of ‘planting as therapy’.

This project is still theoretical and is only at its initial implementation stages perhaps because the population it seeks to serve seem so little understood. Traumatised refugees could benefit from self-healing, sure, but will their primary use of a mobile device be making reference to the nurturing compassion and tenderness project app? Indeed, should its burden of data use in some areas of web connectivity be considered of sufficient value by the users? I would suggest: unlikely, and no. Moreover, Sherry’s unsettling association of his project as one of ‘reclaiming spaces’ akin to ‘guerrilla gardening’ in New York smacks of misguidance or at least oversight given his, and his organisation’s, academic; if not actual, familiarity with the people in question.

A fellow audience member questioned the project’s use of plants in camps of temporary refuge. For many potential users, and even in the Western and Anglican hegemonic traditions, planting and nurturing symbolises settlement. Surely the too-easy interchangeability of ‘sowing’ and ‘solution’ is politically charged, and too self-limiting to be a truly beneficial or sustainable tool in development leadership’s arsenal. Certainly, ‘Nurture Compassion and Tenderness’s’ aims of reducing vulnerability are commendable – but little more. They remain within this field of value judgement precisely because the population this project is designed for is hypothetical, conceptual even – an undefined ‘vulnerable population’. Implementation of the model in its current form in the Syrian temporary refuge situation would surely expose its inefficacy as a life-changing approach to managing psychological vulnerability.

Syrian refugees tae shelter at a makeshift tent camp set up for Syrian seasonal laborers in Al Qaa, Lebanon. Credit: Freedom House, Flickr

Syrian refugees take shelter at a makeshift tent camp set up for Syrian seasonal laborers in Al Qaa, Lebanon. Credit: Freedom House, Flickr

For a project so concerned with being novel, it certainly meets this demand with technological innovation, seeking to bring e-learning to the masses. Perhaps this is facetious, but to really effect change, this model must realise the beauty lies in its simplicity: encouraging self-healing through external actions that promote inner hope. A seed per person is not, in isolation, going to either prevent, nor reconcile, the aftermath of conflict. Disasters, like ecosystems are defined by multiple causes, sustaining factors and future prospects, and as such, systematic approaches must canvas multiple therapeutic responses to most fairly respond to the diverse nature of every person’s psychological health.

 

Image Credit: Tim Patterson, Flickr

Lee Miller: A Woman’s War

‘Change your Life’ is the call to action scrawled across a segment of the Berlin Wall erected outside the entrance to London’s Imperial War Museum. This mantra resonates as one explores the current exhibition of Lee Miller  – Vogue model, American woman and photographer of scenes of a World War II wracked Britain and Europe of which her coverage of the London Blitz and the liberation of Paris are particularly extraordinary.

Image credit: A. Bow-Bertrand

Image credit: A. Bow-Bertrand

Within the context of war, this exhibition documents Miller’s evolving vision of her own, and other women’s roles in life and society. She would be the ideal pin-up girl for a change your life movement. More than that, she is synonymous with the Cubism’s attempt to capture every visual and physical facet of experience, which in part led to her sitting for a series of now ubiquitous portraits by Picasso. MattersduMonde regularly showcases photojournalists who should be on everyone’s radar  for the insights their work offers, but what is rarely exposed in these feature pieces is the implicit suggestion that these artists have crafted their lives, as much as their work.

Image credit: A. Bow-Bertrand

Picasso’s Lee Miller. Image credit: A. Bow-Bertrand

In exploring this exhibition that is at once an astonishing, comprehensive and beautiful retrospective of Miller’s life, I want also to turn the focus towards the nature and social commentary of the oeuvre, rather than linger on the unarguably rich and seductive personal narrative of Miller herself. Indeed, I think she would rather approve of this, given her collection of images that revisit the images of her own modelling shots under Vogue founder Condé Nast, and Dadaist purveyor Man Ray, re-shooting similar scenes with a new eye: one which seeks to offer possibility rather than singularise or objectify. By the late 1920s, she is reported to have said ‘I would rather take a picture than be one’.

Image credit: A. Bow-Bertrand

Self-portrait, Lee Miller. Image credit: A. Bow-Bertrand

In the shifting times and gender roles of the early twentieth-century, this activity was symptomatic of a wider reaching desire to re-write history through words and deeds, or, rather, through coverage of the visceral, authentic and gendered triumphs of a war over binaries, of all humankind.

Miller’s images challenge binaries of male and female, war and peace, offensive and defensive, and typically canvas the quotidian activities and contemporaneously anachronistic adoption, by women, of roles that demanded physical and psychological strength. So too, she catalogues this curation of social and working reform to identify women’s invaluable contribution to the war effort, so seeking to lay the foundations for sustainable life changes.

Segment of the Berlin Wall. Image credit: A. Bow-Bertrand

Segment of the Berlin Wall. Image credit: A. Bow-Bertrand

Alongside Man Ray, Miller resurrected the technique of solarization, or the Sabattier effect, and it is this reversal of the darkest tones following a double exposure to light that affords a magical quality to much of her work as the boundary between highlights and low lights is smudged. She also returned to her fashion roots at Vogue, to become their photographer and reporter in the early years of war, but when Miller met David E. Scherman, a photojournalist for Life magazine in 1942, shortly before America’s entry into the war, for the first time she felt able to pursue a position as US Army war correspondent.

Image credit: A. Bow-Bertrand

Image credit: A. Bow-Bertrand

Image Credit: A Bow-Bertrand

Women in Uniform: Churchill Hospital, Headington Oxfordshire. January 1943, Image Credit: A Bow-Bertrand

In this newfound capacity, Miller was able to map the role of women in the armed forces, often drawing on the surrealist impulses that shaped so much of her work, as in the image above of the glove sterilisation process at the 2nd US Army General Hospital. Deservingly given most attention in the IWM exhibition is her coverage of the siege of St Malo in August 1944 in which she carved out her role as one of the leading war correspondents of the field. Although she was forbidden, as a female correspondent from entering a combat zone, she flouted this accreditation, and as a result found herself under house arrest for a brief period.

Aerial shot. Image credit: A. Bow-Bertrand

Aerial shot, IWM. Image credit: A. Bow-Bertrand

From this baptism of fire, Miller addressed the real health and development crises in front of her, visiting a  total of four concentration camps of which she photographed the states of Buchenwald and Dachau. The images from these sites are intense and overwhelming, delineating Scherman’s description of her artistic method at this time: ‘[she worked] encased in an ice-cold-rage, filled with hate and disgust’. Miller’s work is intensely humanising, making the viewer accomplice in the subjects and activities in shot.

Image credit: A. Bow-Bertrand

The innards of IWM. Image credit: A. Bow-Bertrand

Image Credit: A Bow-Bertrand

Antony Penrose’s exhibition publication, from which many of these photographs are drawn. Image Credit: A Bow-Bertrand

Constantly sensitive to images and experiences of entrapment, Miller’s coverage of war attempts to redefine the feminine within conflict spheres, so too challenging what comprises the ‘wellness’ of a body, and the extent of trauma a viewer can experience by proxy.

Image Credit: A Bow-Bertrand

Wartime Fashion and Lifestyle: Hampstead, London. May 1941. Image Credit: A Bow-Bertrand

Image Credit: A Bow-Bertrand

Women in Uniform: RNAS Yeovilton (HMS Heron), Somerset England. September 1941. A WRNS messenger confers with the pilot of a Sea Hurricane at HMS Heron. Image Credit: A Bow-Bertrand

Her photography attempts to change the lives of those who view it, in a parallel trajectory to the turmoil, imprisonment and liberation arc mapped by her work. Those who view it cannot help but be changed, and moved, surely in a way that demands a more intense scrutiny of the world and our activities on it.

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Liberation: Bricqueville, Normandy France. July 1944. Image Credit: A Bow-Bertrand

Lee Miller in Hitler's bath, Munich, Bavaria Germany. April 1945, David E. Scherman. Image Credit: A Bow-Bertrand

Lee Miller in Hitler’s bath, Munich, Bavaria Germany. April 1945, David E. Scherman. Image Credit: A Bow-Bertrand

Writing the Self: Creating Health (TEDx)

In December I had the opportunity to join the line-up for TEDxUCL in which I shared my personal experience of writing through and out my health, and how this informed the ‘Writing Health‘ section of this website.

You can watch the talk here, and find the transcript following.

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Dear Ana,

You are twenty-five years old, standing in front of some 1000 people in the Logan Hall in London’s Bloomsbury. You are a stone’s throw away from the Institute of Child Health where you are studying for a Masters in global development. You are a five-minute cycle away from the Cruciform building where you began your medical degree in 2010.

You are about to tell them what got you here. Of how an eating disorder saw you hospitalized after A-levels, and about the unwanted deferral of your much coveted entry to medical school, and the subsequent curtailment of it eighteen months later following a relapse.

You are anxious. Anxious that the audience will wonder what merit there is in your talk, whether it’s worth the ticket price, whether you are worth being heard, how it will feel to tell this many people a verbal and very personal narrative of mental disorders only your nearest know about.

You are talking to them. You are highlighting that because we cannot see mental illness, it is hard to understand, but that this talk is still relevant, because all of us in this room seek meaning through connection. This is what you call a sense of being ‘grounded’, and that every listener here will know someone with, or personally experience, mental health disorders at some point in their life.

 Yours, Ana

 

It is true that, of the audience today, approximately 250 of you will experience some form of psychological disorder at some point in your adult lives. That’s one in four of you: one member of a nuclear family, at least one of the people sitting immediately next to you, one of a virtuouso string quartet. But I don’t want to talk about diagnoses or labels, but rather start from an awareness that every one of us has a psychological self, of which we are variously aware.

What is also true is that you all have the capacity to feel, to think, to write. And I want to share how writing is a greatly undervalued tool in appreciating our personal composition and to try and understand how that can become disordered.

It won’t come as a surprise to you that reading can be a form of escapism and writing can be therapeutic. We could look at lots of studies about how the medical humanities (i.e. the cross over between disciplines including social science and literature) are beneficial to our wellbeing, as shown here. And I want to show you tools that might help you at some stage in the way they came to help me. But more importantly, I want to consider why this might have helped.

Mental health is still commonly underrepresented and discussed at both personal and policy levels. But things are slowly changing. As humans we are programmed to try and keep ourselves well and others well. But this begs the question: what does it mean to be ‘well’ or ‘ill’, how can you tell where you sit between those and what happens if you’re not sure?

For those of you hoping for a magic bullet I’m afraid I can’t offer a simple answer, because I don’t think there is one. Instead, I want to offer up Chapter VI of Lionel Trilling’s ‘Sincerity and Authenticity’ in which he adopts Freud’s assertion that “we are all ill – neurosis is of the very nature of the mind. Its intensity varies from individual to individual”.

But one way that we can address the answers to these questions is by entering into a written dialogue with ourselves through language. Through my own process of writing out my health, I came to realize that for me, mental disorder and external modes of control are symptomatic of a version of myself that is adrift from any solid sense of history.

When I was first hospitalized I struggled through the treatment plan and managed to follow the medication and instruction regime until I had convinced myself – and everyone around me – that I was ‘well’ enough to get on with my life and start my medical degree. It was only when I found myself back in treatment again a year later that I realized I couldn’t just do what I was told which was a pretty big deal for someone who enjoyed being liked and accommodating.

When I relapsed I felt broken. I knew that following the rules had only given me an alternative system of false reality which was untenable in the realities of my actual life. More so than ever before I felt completely adrift – completely groundless – unsure how to find a state of physical and mental wellness that was sustainable and thorough. But, what was different this time around was that there were therapy classes of which one was creative writing. Now I’d always adored reading, and writing poetry (very badly I should add) but during those months and ever since words became my grounding: both those I wrote for myself, and to myself, and those of others along the way.

Writing and revising my own narrative strengthened a previously fragile self awareness, and over time I started to initiate and reinforce positive behaviour change by acting as the written me felt able to. As I entered into an understanding of the strengths and limitations of my body and mind so too my collection of journals and notebooks grew. Although they’re now stored away in my Mum’s loft, they became a tangible construct of who I was at that time, in which I expressed myself freely so discovering things I never realized I doubted or feared or hoped for.

That was perhaps the greatest thing: discovering I did actually have and wanted to hope and own a purpose. Someone once told me that the most optimistic people suffer the worst. Perhaps this is true, but just as we all sit on a spectrum of self awareness, so too do we vary in our willingness to have hope for ourselves.

So, writing to and of the self is a wonderful method for creating personal growth and mental wellbeing. Of course, this idea isn’t new. Just as I opened with a letter I’d written to my future self, many of you will have encountered Leslie Pole Hartley’s ‘The Go-Between’ (1953) in which letters become the substance of an alternative reality for two forbidden lovers. So too, John Clare’s letters from the asylum recount his episode spent in an institution for the mentally unstable. His letters written during this time are frequently associated with an othering Clare wrought on himself through the adoption of new personae and life narratives.

Eric Robinson, a prolific editor of John Clare, has suggested that in these letters ‘it seems as if Clare is struggling to retain his sanity by writing down each image as it floats into his mind’[1] which echoes true in his poem ‘Shadow of Taste’: ‘in living character and breathing word / Becomes a landscape heard and felt and seen’ (ll. 72-3).[2] This psychological mapping of moments and territories became crucial to constituting and re-constituting the land and self for Clare.

‘Writing health’ is a process of self-development and prompted me to create a blog platform which invites multimedia contributions from all people on mental health and has produced some deeply moving and reflective pieces. Take David, a medical researcher who contributed a piece called ‘Autumn’ in which he tried to make sense of his role as clinical practitioner and facilitator on a placement in a psychiatric tertiary care unit.

This model of writing for health offers a construct through words that can either be used to create a fuller or more representative evaluation of who you are at any given moment or as labels to distance oneself from. For instance, during my treatment for disordered eating I was encouraged to write a letter to the ill me which challenged what it means to be ‘ill’ and ‘well’ forcing a degree of disassociation. This became one of the most formative steps in my recovery progress enabling me to detach myself and my physical health from mental imposters. This was followed up with a letter to my future self allowing me to engage with the parts of me that were healthy, sustainable and carried personal integrity.

There is purpose in writing a letter; there is a need to actually create something rather than just a process of expunging. I want to encourage you to create a self-portrait in letters channeling a modernist focus on the interiority of the self. Modernist writers, including Freud, James Joyce and Virginia Woolf were among the first to prioritise the entangled nature of the self and a ‘turn inward’ that is increasingly relevant today.

You will see that you all have a postcard on your seat. I would like to invite you to pick it up and keep hold of it until I finish. Who has heard of Andy Warhol? Good. In 1949, the managing director of Harper’s Magazine Russell Lyne wrote to a then unknown Warhol requesting biographical information. To which the 21-year old artist replied: Hello mr lynes / thank you very much / my life couldn’t fill a penny postcard.

What you are holding now is the same size as one of those early 20th century penny postcards. I’m pretty certain we all agree that Warhol could have more than a postcard written about him these days. But it isn’t about the quality or quantity of what you write either to yourself or to others. It is about using words with integrity – by that I mean penning thoughts instinctively and without restraint – to create a verbal self that can help to reflect on, and reflect who you are, at any given point. So there’s only one thing left for me to do.

 

Dear audience,

I have shared with you a biographical history, but more importantly this talk has helped write out why and how composing letters got me from feeling completely detached to being able to feel grounded. Keep hold of that postcard, and when you can, write something. Perhaps to a past you, a future self, or how you are right now, whatever feels right. Just write with abandon and you never know what you might learn or the self care you might establish.

 And I want to leave you with another example from the fantastic ‘Letters of Note’ collection that is about as far away from Warhol as you could possibly get. On May 4th, 1941, the renowned American sociologist Jessie Bernard wrote a letter to her first child, a then unborn daughter. It opens: ‘my dearest, / Eleven weeks from today you will be ready for this outside world’.  

You, listeners, readers, writers are already living in and through this outside world. But whether you are ready or not, writing out our experiences in it can help make a lot more sense of it as we grow-up in it right to the very end. 

Yours,  Ana.

 

 

References:

[1] Clare, The Oxford Authors, p. xxiv.

[2] Clare, The Oxford Authors, ‘Shadows of Taste’, p. 171.

Image Credit: Lulu Fernandez