This equivocal dust: a review of Material Cultures of Psychiatry,edited by M Ankele and B Majerus

Topics such as the criteria for diagnosing mental illness, the institutional arrangements for treating the mentally ill, or the exclusion related to having been consigned to a mental institution are not so much topics of the past, as topics with a past. One is aware that invoking that past has become to some extent ritualistic, but this does not make having that past in view any less important, or any less fraught with impasses. The history of psychiatry, at least when conceived as histoire d’en bas, has already reconstructed numerous portraits of individuals, recovering traces of real lives from the ruins of classification systems and institutional metabolism.

In painting portraits, artists used to subtly place objects that reflected the biography or ambitions of the subject, but it is only more recently that objects that were part of the everyday life of institutionalized individuals became themselves part of the narratives offered by historians and other scholars of psychiatry. Excavating these remains – and finding ways to listen to them – is part of telling a fuller story of the people who lived for many years in mental institutions, and indirectly of madness as both part of medical science, and a figment of our culture.

In the spring of 2018, the conference Material Cultures of Psychiatry was set to explore precisely such barely habitable spaces of what-remains, with a mix of scholarly, pedagogical and artistic contributions. Three years later, a selection of those contributions was published in a book, edited by Monika Ankele and Benoît Majerus (2021). ¹ It is a rich collection, which could be of particular interest to those scholars who usually only read English, since it makes available research done in other European languages (mostly German and French).

The book is divided in to five parts, the last of which is dedicated to pedagogical/artistic projects. Interspersed in the other parts are more instances of art. As none of the works are purely visual, a photo or a few pages of transcript cannot do justice to the materiality and performativity of these contributions. To refer to just two examples, the fragility of Lydia Oertelt’s bread amulets (p. 185), or the smell of home- versus hospital linen used evocatively by Daniela Hoge (p. 226), can at best be reimagined by a reader. It is for this reason that I will not discuss the art works any further. This is not a comment on their value, but I part ways with the editors when they write approvingly of ‘the idea of artistic research as a practice-based method of knowledge production that highlights the epistemic value of artistic methods’ (p. 24). It does not seem to me that art is in need of such a badge of approval.

The book is at its best in those chapters that, while approaching topics of material culture, are still quite firmly anchored in the customary methods of the historian or anthropologist. This means essentially that they continue to work with archival sources and accept texts as instrumental to tracing the trajectories of the focal objects. Naturally, these chapters do not stop at that, but include other approaches, such as recreating the experiences of patients in interacting with objects, or seeing the objects as affordances, their prescribed use sometimes superseded by utilizations initiated by patients. The window of autonomy opened by repurposing or ‘appropriation’ of things is one of the volume’s leitmotifs.

As Majerus (2011: 99) has suggested elsewhere, ‘the return to ordinary objects’ inherent in a material culture approach may help with mapping the distance between textbook norms and the realities of psychiatric treatment, and also that between the intention manifested in the design of objects (e.g. the hospital bed), and the experience of living with, and of taking over, such objects. Introducing the present volume, Ankele and Majerus (2021) also note that exploring the multitude of stories that cling to objects has helped moderate anti-psychiatric excesses (p. 15), allowing for a more sober view of the history of psychiatry. Moreover, this approach integrates naturally the context in which objects are experienced, for example spatial interventions – what Ankele (2019: 73) has called ‘staging’ (Inszenierung). Such strengths are apparent in many chapters of the book, with some exceptions – when theoretical commitments, notably the ideas of Bruno Latour, solidify into something close to jargon for jargon’s sake. Let me now briefly go through the chapters, focusing on those I found more convincing.

In the first part of the book, the chapter by Anatole Le Bras stands out, both in terms of style and of quality. It is a solid piece of historiography on practices of seclusion in rural France in the nineteenth century. The shed (cabanon) used to hide, control and confine the mentally ill was a scandal for both alienists and enlightened urbanites in general, and it gave ‘the yellow press’, i.e. tabloids, ample opportunity to regret the backwardness of the peasants when describing the conditions of confinement in all their grotesque misery. It was also a topic for colonial psychiatry, which found, in the use of sheds, confirmation of a much vaster conceptualization of the colonized as (quasi-)savages. As Le Bras aptly emphasizes, for the confident and militant alienists, the shed was the ‘antimodel’ (pp. 76 ff.) of their medicalized and paternalist-humanist perspective on madness.

A number of important topics intersect here, and the chapter brings them clearly and concisely to light. A certain modern impatience with presumed archaic practices clashed with real instances of mistreatment and cruelty. Doctors were eager to extend their dominion, but, at least in some cases, that zeal should be seen in a context in which some families sought to accelerate the death of their mentally ill relatives. Moreover, scientific views confronted popular myths, such as the idea that the insane were less sensitive to pain (one in a long series of parallelisms, I should note, between the mentally ill, children, ‘savages’ and animals). This tension also had a substantial legal dimension, as traditionally the household or the family had been opaque to legal surveillance and intervention, a kind of sovereignty that was no longer tenable in the eyes of the medical profession. An object like the shed acted somewhat like a lightning rod for all these tensions.

The first section of the book also includes Kai Sammet’s essay on light in a German asylum, and Lisa Landsteiner’s study on the use of chairs and sitting in mental institutions. Both chapters combine meticulous description with commentary that quickly becomes excessively theory-heavy. Sammet examines light’s deployment as both Foucauldian ‘disciplinary technology’, and a ‘medium of communication’ (pp. 56–7). The documentation of considerations of ‘lightscape’ in asylum architecture (including via reproductions of blueprints) is, in my opinion, the most informative part of this chapter. Landsteiner’s text follows a similar trajectory. Seeing through the ‘implicitness’ (p. 120) of sitting is important – for example, as the author suggests, it can be connected to (institutional) waiting, and thus to tangible effects of power. In this case, too, attempts to recover the unadulterated patient experience seem fitting, but a reader who does not share the methodological orientation of the authors may doubt the effectiveness of their attempts. There is only so much that can be made out of the fact that only staff sit at desks (p. 123).

The fourth chapter in the section, by Linnea Kuglitsch, presents more interesting and more robust research. It is a commentary on the distance between norm and practice in American asylums in the era of moral treatment. The therapeutic doctrine at this time was based on micromanaging patient experiences, which included controlling their access to, and use of, natural objects. The archaeology of the asylum has to be taken in the literal sense in this chapter, as two animal remains recovered from two former asylums provide the pretext for the larger plot. Thus, a whale vertebra was possibly part of a collection which may have been used therapeutically, i.e. an interest in curated nature was encouraged, as a healthy exercise of mind. On the other hand, the remains of a sand dollar (sea urchin) found in a dump could be indicative of efforts by patients to bypass the strict rules of the institution (cleanliness!), and to reprivatize experiences by smuggling in illicit fragments of nature. These stories are by necessity speculative, but some such stories must be true, and the picture they paint of moral treatment at work is rich in nuance.

The second part of the volume opens with a chapter by Monika Ankele on ‘textile architecture’, an account focused on objects created by patients out of materials such as linen or wool, which they managed to refashion even in the sterile environment of isolation cells. The practice of seclusion as both security and therapeutic intervention, and the debates around this English import in the German-speaking countries, form the background for a discussion on the uses of textiles in mental institutions.

Following the archival footprints of two female patients, Ankele’s chapter presents a moving image of the suffering of these human beings, as expressed, fleetingly and uncannily, in fabric torn from bedsheets or mattresses and remade into puzzling objects. Marie Lieb, hospitalized in Heidelberg, created elaborate patterns from pieces of linen, while Katharina Detzel, a patient of Klingenmünster asylum, fashioned a life-size doll from canvas. Both women were held in isolation cells, so their creations have special significance. Detzel, for example, may have been trying to express the anguish of isolation by hanging her doll from a lamp. It is telling that her situation did not improve – she was subsequently still kept in isolation, but with no clothes, mattress or blanket. What she did, under any description, was a disruption of the intended use of the objects in her cell. Was this also a way of resisting the default meaning of a canvas blanket in an isolation cell – with all the ramifications of such an action? This must remain moot, I think, but Ankele is still right to make suggestions on these lines. The patients, after all, did not merely derail objects, they did not stop at tearing things apart, but remade them into forms. The decisive point here is that institutions tended to read such actions as merely an aggravation of symptomatology, and reacted accordingly.

The following chapter, by Katrin Luchsinger, flows naturally from Ankele’s account. There is a certain continuity of method, as Luchsinger excavates medical archives to follow one patient and her use of a fragile material, and then there is the continuity generated by the fact that this very material is one we have already met: Varek or seagrass. The focus of the chapter switches repeatedly from stage to character. The stage was the Rheinau asylum near Zurich at the beginning of the twentieth century, the declination of moral treatment as work therapy, or the uses and connotations of seagrass in this context; the character was the patient Lisette H., who had extraordinary skills in knitting seagrass. Luchsinger describes in detail several surviving objects created by Lisette H. (such as a hat), and contrasts what these suggest about the patient with what medical evaluations saw in her – bluntly put, very little, as she was considered a hopeless case. I would argue that more than in the case of the textiles patterns described by Ankele, translating the evocative nature of the Varek objects is both plausible and problematic. The reference to Goffman’s idea of ‘underliving’ is revealing, but first of all about a type of experience, and less likely about the minutiae of a person’s experience. Witnessing Lisette H.’s fate, perhaps we express mostly something about our own sensitivities when reading approvingly of ‘the grieving expressed in her choice of motifs’ (p. 167).

The other two chapters in this section discuss the use of two quite different technical devices in psychiatric institutions. Max Gawlich’s piece on electroconvulsive therapy seems closer – as a matter of theoretical compass – to what Ankele and Luchsinger propose, than the remaining chapter in the section, a study by Louise Hide on the introduction of TV sets in mid-twentieth century British mental hospitals. Gawlich’s chapter is convincing when anatomizing the vagaries of determining the ‘right’ dose of current, or the seduction of standardizing treatment, but it becomes formulaic when it elaborates on its philosophical allegiances.

Hide’s contribution changes the scenery to an era when television was an explosive social phenomenon, its expansion having been felt even beyond the gates of mental institutions. It is not the objects themselves – the TV sets – that are the focus of the chapter, but rather the novel activity, or experience, they generated: watching TV. As TVs became focal points of family life, Hide argues convincingly that in psychiatric wards, too, they functioned as proxy for a certain ‘ideology of domesticity’ (p. 186), which perhaps even emanated to the patients in the form of a ‘domestic atmosphere’ (p. 190) – think patients watching shows together with nurses. This can be seen as a step towards what would soon become the offensive to deinstitutionalize (most) patients. That horizon aside, Hide captures the subtle radiation of changing mores and consumer tech into the increasingly permeable microcosm of the psychiatric institution.

The third part of the book is more uneven in terms of both approaches and quality. The centrepiece of the section is, in my view, Stefan Wulf’s study on the presence of pianos in asylums. The chapter discusses two major composers, Robert Schumann and Paul Abraham, and their experiences as psychiatric patients. Schumann spent his final years in the Endenich clinic, in the 1850s, while Abraham became a patient of the Eppendorf clinic in the 1950s, upon his return to Germany. Both had intermittent access to pianos, and these instruments, Wulf shows, seemingly tied together the stories of the composers’ lives as patients. The pianos manifested their intellectual degradation, as the two men struggled and failed to play or compose. The instruments also became part of the observations and therapeutic narratives of the doctors, and they were part of the stories told by friends and family, anchors for hopes and grief.

Wulf’s reconstruction of the role played by the asylum pianos across numerous sources is remarkable, and his commentary adds a stratum of nuance to the documentation. An example is his argument that providing access to a piano for a famous patient was not simply a decision derived from therapeutic considerations, although such considerations are predictably part of the medical paper trail. It was also, covertly, a public relations stratagem, given the interest of tabloid news-papers in the matter (p. 274). Letting the public know that the stricken genius was not only doing well but also playing, thanks to modern medicine, was unimaginable without the presence of the piano in the institution.

Two other substantial studies are included in the fourth part of the volume. Marianna Scarfone assembles a poignant album consisting of objects – and stories – abandoned in the storeroom of the Perray-Vaucluse hospital near Paris. The metaphor of the ‘dig’ is appropriate here, even if the space that is ‘excavated’ was functional merely two decades ago. What we see is indeed a ‘lost world’ (p. 302), the ruins of which are diary entries and photos and poems, cigarette packs and clothes. The latter, for example, are part of a long exchange between patient preferences and institutional mores: Who got to wear what and when? Were personal clothes allowed, and could a ‘total institution’ be flexible about uniforms?

I am not sure if all these ‘strata’ can be seen as amounting to a voice of the patients as Gramscian ‘subalterns’ (p. 304), as the author suggests. As with all ruins, a heavy silence seems to hang over what these people left behind, pieces of their lives which persist as if to mark an irreversible loss. But clearly the written material can speak, and some of it hits hard: a poem of self-mourning, blaming the cruelty of the world, or a diary entry noting that the following day the patient would suffer a lobotomy. At least to this reader, this was close to a vanitas pilgrimage.

Maia Woolner’s chapter on the use of graphics in describing the evolution of symptoms is less emotionally charged, which is natural given its subject matter. It presents, however, excellent material for the history and philosophy of science, and perhaps the most rigorous analysis in the book. Seeking to consolidate their profession’s aura of scientificity, psychiatrists included the adoption and generalization of charts as part of its standardization efforts. Temporal evolution was, after all, one of the focus points of diagnostic systems, so uncovering the ‘temporal shape of each pathology’ (p. 357) was thought to matter greatly. It also mattered that these representations had what Woolner calls, with an apt borrowing, a ‘physiological aesthetic’ (p. 359). Bearing the marks of natural science seems almost a gesture of hopeful magic in the attempt to avoid the vagueness of language and ordinary psychological explanations. This goes, I should note, not only for the history of psychiatry, but for the larger edifice of psychological sciences as a whole.

It is a corridor of exhibits that the reader walks through in this volume, and they have an almost Pompeian fascination: a pedagogical whale bone, a canvas doll summoned to counter the emptiness of an isolation cell, an elaborated seagrass hat, a maladroit poem, a piano that escapes that mastery of the former master. We stir the dust of what, to the more fortunate, were often little lives, and this is perhaps the most we can still do.