41
Diaries,
Self-talk, and Psychosis: Writing as a Place to Live
SAGE Publications, Inc.200610.1191/0967550706ab030oa
BrendanStone
University of Sheffield, UK, b.stone@shef.ac.uk
Address
for correspondence: Brendan Stone, Department of English Literature, University
of Sheffield, Shearwood Road, Sheffield S10 2TD, UK; Email: b.stone@shef.ac.uk
In this paper I consider
the therapeutic consequences that writing, and in particular, the writing
of a diary, may effect for those subject to the intense distress of psychosis.
I have taken my lead from two sentences at the close of a journal kept by
a woman hospitalized with an acute psychotic disorder. Subsequently published
as Phone at nine just to say you're alive, this text records the trajectory
of Linda Hart's year-long illness. Writing on the day before she returns
to work, Hart (1997: 352—53) makes the following bold assertion concerning
the efficacy of keeping a diary: `Writing this journal has kept me on the
edge of sanity. Without it, I believe I would have tipped over into the chasm
of madness from where I could not be reached.' With reference to Phone
at nine, and also to another hospital diary published as These are
my sisters, in which Lara Jefferson makes similar claims to Hart's, I
consider here whether writing can really ameliorate the devastation of psychosis.
My central contention is that the process of writing is beneficial because
it is able to attenuate the malformation of identity characteristic of so
much acute mental illness.
PSYCHOSIS
AND WRITING For a man who no longer has a homeland, writing becomes a place
to live. (Theodor Adorno, 1974: 87) Writing on the day before she returns
to work after a lengthy period hos- pitalized with an acute psychotic disorder,
Linda Hart (1997: 352–53) makes the following assertion: `Writing this
journal has kept me on the edge of sanity. Without it, I believe I would have
tipped over into the chasm of madness from where I could not be reached.'
She is not alone in
42
claiming
that writing can ameliorate the depredations of madness.1 In a hospital journal
written 40 years before Phone at nine, and also produced in the midst of acute
mental disturbance, Lara Jefferson (1975: 112) makes similar assertions, describing
her writing as a `ladder of words – strong enough, and long enough – to reach out of this'. At the end of her diary, shortly before she is transferred
to an open ward, Jefferson declares that writing has been instrumental in
her recovery: `I kept writing in an effort to escape [madness] . . . I have
sat through floods of raving and built a barrier – a breakwater of
small black words around me' (1975: 236); and suggests that if she had not
written she might instead have been relegated `to a place still lower in this
limbo' (1975: 238). Hart's diary records a prolonged episode of severe mental
illness in 1985 during which she was compulsorily hospitalized; the text begins
with her transfer to a locked ward in a Leicestershire psychiatric unit, and
ends the day before she returns to her job, working for social services in
the field of mental health care. A literate, intelligent woman, it becomes
clear as the diary progresses that Hart is from an impoverished and abu- sive
family background (Hart, 1997: 186–89). However, the text reveals relatively
little about her history and is far more concerned with recording everyday
life on the hospital ward, presenting often mundane descriptions of interactions
with friends and relatives who visit, and conversations with nurses and doctors.
Although when published, Phone at nine went on to win the 1996 MIND book of
the year award, it is important to bear in mind that the text began life as
Hart's personal diary, transcribed at the time of her illness. This is evident
in its form, and particularly in its omis- sions of many of the narrative
signposts that one might expect to find in a memoir: explanatory, scene-setting,
reader-orienting lexia are absent. In Phone at nine the reader discovers key
information about Hart's psychi- atric history only in textual asides, as
if by chance. It appears, on the whole, to be an unembellished record of Hart's
day to day experience of hospital life and reads as an ongoing, contingent
facet of that experience. Similarly, Jefferson's text, first published in
1947, traces the in-progress fluctuations of a negotiation with self and madness.
Although a more self- consciously literary work than Phone at nine, These
are my sisters also largely consists of observations of everyday hospital
life, and in particular detailed accounts of the experiences of Jefferson's
fellow patients – the `sisters' of the book's title. Like Hart, Jefferson
provides little background information about herself prior to entering hospital.
According to Anthony Whitehead's introduction, Jefferson was `labelled as
suffering from schiz- ophrenia and committed to a mental hospital in the Midwest
of the USA sometime just before the second World War' (in Jefferson, 1975:
3). The publisher's notes state that the original manuscript was discovered
in the `violent ward of a state `Mental Hospital' . . . pencilled on an odd
43
assortment
of scrap paper' and `was not written for publication'. An intro- duction to
the original American edition of These are my sisters goes on to say that
Jefferson was `unavailable' to prepare a preface, but it does not specify
whether she was contacted and refused or was unable to be traced. Exergual
material from the British edition published in 1975 states that Jefferson
died in the late 1940s, but that, apart from her text, little else is known
of her. It is plain that both Hart and Jefferson are living through chronic
distress at the time of writing. Hart writes: `Deep down I feel like I'm living
through the last few weeks of my life . . . I cannot envisage a real life
or a future' (1997: 83). Her psychosis is manifest in auditory hallucinations
of her dead father's hostile voice; this characteristic entry describes her
symp- toms: `Very tormented all day. My father is interfering with my thoughts
by putting images of me, dead by violent means. In particular, one with my
stomach shredded and maggots spilling out' (1997: 207). In These are my sisters,
while demonstrating an awareness that her madness has been exac- erbated,
even caused, by oppressive social and gender mores, Jefferson emphasizes the
fact of a suffering in which mania and despair alternate. She writes of her
condition as like having `nothing solid to stand on – noth- ing beneath
me but a vast treacherous quagmire of despondency' (1975: 21). And while such
abyssal experiences are sometimes `followed by peri- ods of exultation and
ecstasy', this hypermanic bliss leaves her drained and debilitated; madness
`caught me and swept me – where I do not know. All the way through
hell – and very far into heaven. Now it has whirled and left a stranger
unknown to me. Sitting here in my body, I am weak, sick, and vomit much, and
stagger so I can hardly walk' (1975: 18). MADNESS AND THE SHATTERED SELF Although
Hart and Jefferson do write of their distress, their descriptions are brief,
and neither text includes a great deal of psychological analysis or revisiting
of their authors' histories. What is it, then, about keeping their diaries
that prompts Hart and Jefferson to so unequivocally denote writing as a key
factor in recovery? How can recording one's meals, the weather, the names
and occupations of those one is hospitalized with, one's occa- sional trips
out at weekends, affect mental health? To attempt to answer this, I want to
turn first to a recurrent theme in Hart's journal: the way in which she experiences
the very foundations of her identity as threatened by her illness. In the
following description, early in the text, she touches on several of the themes
I want to deal with here: `Today my father has attempted to get control of
my mind. He does it by subtle means. Taking away my speech, closing me down
and taking me away from the world' (Hart, 1997: 14).
44
There
are three points in this passage I wish to highlight. First, psy- chosis effects
a suspension from the social realm (`taking me away from the world'). Secondly – and a means by which this suspension is effected – it is experienced
as a muting agent: it involves the loss of speech. That is to say, Hart's
internalized image of the dead father threatens her existence as a speaking
subject, and this in turn absents her from the consensual world of discourse
and action: by taking away her speech, madness also removes her from the world.
Thirdly, and as we shall see intimately con- nected to the preceding two points,
Hart denotes that her sense of selfhood is under immediate threat: not only
is her `control' over thought weak- ened; not only is her ability to speak
`for herself' and act in the world attenuated; in addition, she notes that
her father is `closing me down'. This felt `closing' of the self is subsequently
described in various ways. A particularly disturbing example is the way in
which her father's voice repeatedly urges her to literally make herself disappear
by killing herself. Linked to this theme, the voice also conjures up images
of death, decay and absence. Thus, when Hart records that, `his voice became
more insis- tent. He told me my skin was coming off and that I could disappear'
(1997: 33), madness manifests as an impression of bodily disintegration – a powerful image of the nullification of the self. Many accounts produced
by those who have experienced madness emphasize, as Hart does, the radical
disruption to a settled sense of iden- tity, a felt impression that selfhood
and being are under imminent threat of complete disaggregation. A powerful
example is found in an account of manic-depression by `David', a young man
whose narrative has been recorded by James Glass (1989: 34 and 37): `I hear
this voice sometimes ... it always tears away at me, rips my identity into
shreds, and slices away at everything I am ... It's like my cells are exploded
over the universe ... you're left trying to find yourself amidst this infinity
of particles.' Similarly, in her journal, Jefferson (1975: 19) describes madness
as subsuming the self; it is a `flood ... swirling about me . . . sucking
me under ... there is only a shadow remaining of the person I used to be'.
Such observations concerning the disruption of selfhood in psychosis accord
with the opinions of a wide variety of commentators on mental ill- ness. In
the mainstream of psychiatric opinion it is axiomatic, for instance, that
the psychological process known as dissociation, which involves troubling
alterations in the sense of self, is common to many different psychological
disorders (see Saxe et al., 1993; van der Kolk and van der Hart, 1995), and
physicians such as Bleuler (1966), Jaspers (1962), Federn (1952), Freeman
(Freeman et al., 1958), and, more recently, Spitzer (1990), Helmsley (1998),
and Fabrega (1989) have contended that, specifically in the case of psychosis,
this disruption is particularly acute. In addition, clinicians such as Richard
Grossman (2000) have tracked
45
the disintegration
of self in depression and in narcissistic personality disorders. Notwithstanding
disagreements over aetiology, commentators from the more critical fringes
of the human sciences and the humanities concur. For example, David Mann (1991:
216) insists that `what is most important about psychiatric ailments ... is
that they can be understood as losses of self'; Robert Young (2004: para 28)
comments that, for the psychotic, `fragmentation of self becomes the norm'; James Glass (1989: 2) notes that psychotics `experience themselves as inhuman,
as things or objects, as pieces of dead matter' and writes of the shattering
of a `core sense of self' (Glass, 1993: 27); David Levin (1987: 522–23)
avers that `the suffer- ing of the schizophrenic ... divides the Self ...
and threatens to destroy ... integration and wholeness'; while Marta Caminero-Santangelo
(1998: 103) writes of `the absolute powerlessness of one who cannot completely
claim the `I' for herself'. Madness, then, throws the feasibility and constitution
of human iden- tity into question: what had been taken for granted is opened
to challenge and uncertainty, and the whole basis of what makes selfhood viable
may need to be urgently reformulated. And, unless we are to cast the mad as
utterly removed from our own particular strain of humanness, even those of
us believing ourselves to be untouched by madness may feel obliged to confront
the questions raised about everyday understandings of personal identity. EGO
IS SHE WHO SAYS EGO I suggest that Hart and Jefferson make the claims they
do for diary writing because by this means they are actively reforming their
shattered senses of selfhood. On one level it is not difficult to see how
asserting a `voice' in the context of a journal might alleviate the erosion
of voice which Hart describes as concomitant with psychosis. That is to say,
in the diary the `voice' on the page is more identifiably the writer's, rather
than emanating from an external source. To write, therefore, may be to counter
voiceless- ness. But rather than end with this (overly simple) observation,
I think there is a lot more we can learn from the implications of Hart's and
Jefferson's claims. To begin to follow through these implications, I want
to turn now to that strand of theory which challenges notions of the self
as transcendental essence, and posits human identity as intimately bound to
language. One of the most influential proponents of the linguistic basis of
subjec- tivity is Emile Benveniste. In Problems in general linguistics he
makes the famous assertion that it `is in and through language that man constitutes
himself as a subject, because language alone establishes the concept of
46
“ego” in reality, in its reality' (Benveniste, 1971: 224). `Subjectivity', he goes
on, `is only the emergence in the being of a fundamental property of language. “Ego” is he who says “ego” ' (1971: 227). To put it simply, to signify
is also to be, or more accurately, to effect being. Following Benveniste,
and referring to the work of Derrida and Lacan, Anthony Kerby (1991: 72) argues
that subjectivity is constituted in the `presence of the voice', and that
`soliloquy', as he puts it, `is especially important to the question of self-identity'.
Arguing against Husserl, Kerby questions `expression theories of meaning',
in particular the notion that verbal expression is a `duplication or reproduction
of a prior stratum' – specifi- cally `the interiority of consciousness'
(1991: 74). In line with Derrida's arguments in Speech and phenomena (1973),
he contends that expression `generates the subject and object (qua intended)
presupposed by it' (Kerby, 1991: 74), and that `the disclosive power of language
is formative of the subject' (1991: 82). Considering the question of whether
a subject existed `preceding expression', he contends that `in solitary monologue
one's expressions ... render the meanings of one's experiences or states present
to oneself' (1991: 76). For both Kerby and Benveniste, then, the very marrow
of subjectivity is sited in a lexical reservoir: Those iterable words that
are always at my disposal are my lifeblood, for it is here that a certain
self-consciousness arises and is constantly renewed in the form of hearing
oneself speak. It is perhaps this relation . . . that best founds our sense
of subjectivity or self-consciousness. (Kerby, 1991: 77) Intriguingly, the
notion that it is via the use of language that selfhood is constituted is
not only representative of a strand of theoretical thinking on subjectivity,
but is also broadly consonant with more empirical work in psychology and neuroscience
on the role of `self-talk' or `inner speech'. The extensive work of neuropsychologist
Alain Morin on the constitution of selfhood and its relation to inner speech
is of particular interest in this regard (see Morin, 1993; 1995a; 1995b; 2003; Morin and Everett, 1990). In a co-authored piece, Morin contends that the
self `acquires information about itself' and forms a `coherent picture of
what it is' by `talking to itself about itself' (Morin and Everett, 1990:
338). Inner speech, he argues, is critical for the development of self-consciousness
and self-knowledge: conscious awareness is not only dependent upon but `almost
synonymous with our “inner voice”' (1990: 341), and is `probably
one of the most important cognitive processes needed in the development of
the cognitive self' (1990: 342). Addressing the alleviation of mental distress,
Morin and Everett (1990: 351) suggest that `low self-conscious subjects' might
be taught `to talk to themselves about themselves', and note that `when irrealist
cognitions are at the core of clients' problems, introspective
47
self-talk
could be learned to identify and change maladaptive self-talk'. In a very
similar vein, the neuroscientist Bernard Baars (1997: 77) describes schizophrenia
as an inner speech `that has run out of control', and sug- gests that a possible
treatment might be to `teach schizophrenics to speak to themselves in different
voices, at will, to regain control over the inner voice'. The arguments of
Benveniste, Kerby, Morin and Baars enable us to read beyond the content of
Hart's and Jefferson's journals and to grasp their broader importance. If
`personhood is dependent on expression' (Kerby, 1991: 123), then an easily
overlooked redemptive function may adum- brate the process of inscription.
My suggestion is that the journals of Hart and Jefferson are textual examples
of the kind of soliloquizing Kerby invokes, and that by this means their authors
are (re)fashioning shattered identities. To claim that this chain – from self-talk to selfhood – is a propitious one in the context of
psychosis accords with observations by psychiatrists Davidson and Strauss
(1992: 131), who argue that `an enhanced sense of self' can provide persons
suffering from `prolonged psychiatric disorders' with a `refuge from their
illness and a foundation upon which they may then take up the work of recovery
in a more active and determined fashion'. When they go on to argue for the
necessity of conducting a `personal inventory' (1992: 136) and speak of the
crucial role of asserting the `voice' and controlling `attention' (1992: 140)
if the patient is to cultivate a sense of selfhood and agency, their argument
reiterates that controlled self-talk is of critical importance to psychologi-
cal well-being. Seen in this light, seemingly simple sentences in Phone at
nine, in which Hart's `I' assumes the place of subject, or which, having assumed
that placing, describes and comments on existence, take on a new signifi-
cance. For example, in the entry for 20 November, Hart first implicates herself
in her consideration of another patient, and then moves on to describe this
other: `I haven't yet had eye contact with Pam. She wears the same clothes
each day and night and her black hair gets more and more greasy' (1997: 11).
Here, by taking up the position of the first person, a self, or a sense of
selfhood, is established which enables the speaker to look outside herself
from that position. The `technologies' at work also include the focusing outside
the self, the attending to the external, inter- personal realm as a counterweight
to the internalizing energies of psy- chosis. But for the moment I want simply
to highlight this assumption of the `I' as a necessary prerequisite to such
subsequent works of the self. To clarify, I should emphasize two points. First,
I am invoking self-talk as a process by which the self, in a willed and self-conscious
movement separates itself from the flux of existence and speaks to itself – and which here is externalized in textual form. The diaries of Hart and Jefferson
48
represent
reclamations of the `I', willed occupations of the ground of first- person
discourse in which consciousness gathers itself and speaks with one voice
into a multiple and frightening cacophony. Thus, and secondly, the way that
such diaries reclaim selfhood is not (only or primarily) by producing a narrative
account – a story – of the self. Rather, identity is established
by means of assuming the subject position of an `I' within language, simply
by speaking/writing as an `I', or to adapt Benveniste: ego is she who says
ego. To such contentions the reader might object that speaking as an `I' is
a part of most personal speech and as such represents nothing remarkable but
is simply a reflex or a grammatical habit. To counter this, I could cite the
observations of, for instance, Richard Jenkins (1996: 40)2 or Louis Sass (1998:
491) that chronic mental distress may lead to individual diffi- culty in understanding
and using the first-person singular, but a more pro- ductive approach might
be to look closely at and differentiate between particular modalities of `speaking',
and in particular between what we might designate `everyday speech' and the
type of discourse being formulated in the diaries. It is with this distinction
in mind that I have highlighted the importance of self-awareness and will
in Hart's and Jefferson's `speech'. In the same vein, Baars (1997: 131) hints
at an important difference between modes of speech when he emphasizes that
`very similar voluntary and nonvoluntary actions' are experienced as radically
dissimilar. `EVERYDAY SPEECH', AND SPEAKING OF THE EVERYDAY To elucidate this
distinction further it will be helpful to consider briefly an essay from Maurice
Blanchot's 1969 text The infinite conversation entitled `Everyday speech'.
This piece illuminates my argument, although perhaps not entirely for the
reasons that Blanchot intended to highlight. His overriding purpose is to
redeem the quotidian from its tainted status as an unexamined and hence unlived
existence (after Socrates' maxim) by indicating, and to an extent celebrating,
its subversive undercutting of comforting illusions of self-presence, and
ideals such as value and judgement; Blanchot aims to resist the valorization
of mastery concomi- tant with notions of `self-awareness' and self-control.
In `everyday' being-states, he argues, `speech' is typically absentminded
and unaware of itself; and the corollary of this is that when we exist and
move within this realm we are barely conscious of ourselves as selves. The
forgetful unaware state of everyday speech is the antithesis of a fortress-like
sovereign ego bolstering itself by excluding and denying otherness: the everyday
and its mode of speaking represent `the power of dissolution' (Blanchot, 1993:
242).
49
However,
Blanchot also notes that potential dangers lurk in the realm of `everyday
speech', and these reservations are important to consider in my context here.
He observes that because the `day-to-day indifference' of the everyday puts
`into question' the very notion of a subject, it `tends unerr- ingly to weigh
down into things', and is a medium in which `alienations, fetishisms, and
reifications' may flourish because of the lack of an engaged awareness to
resist and divide the unconstrained flow of impres- sions (1993: 245). Moreover,
the individual labouring in a monotonous existence who has only the everyday
is `he for whom the everyday is most heavy' (1993: 244). For the vulnerable
subject, therefore, the everyday's effacement of subjectivity, and in particular
its effacing of the subject's sense of separateness from existence, leaves
him or her wholly subsumed by oppression: `the person no longer exists in
his or her personal identity ... the one afflicted no longer has any identity
other than the situation with which he merges.... This is the trap of affliction'
(Blanchot, 1993: 131 and 132). So, while the realm of everyday existence counterbalances
western obsessions with self-control and self-knowledge, the exigencies of
suffer- ing would seem to demand humility and caution on the part of the cultural
critic. And, in the context of madness, Blanchot's notion of the sedimented
fetishisms of the everyday have a particular resonance. For Hart, the fetishisms
of everyday speech include the virulent antipathy and ceaseless murmur of
her internalized father: subsumed by this, she is in danger of complete capitulation
to an unbearable everyday composed of hostility and fear, or, as she puts
it, lost in a `chasm of madness' (1997: 353). This subsumption, indeed, might
serve as one definition of the particular ago- nies of psychosis: deprived
of a coherent `I', the psychotic is akin to a character trapped in a nightmarish
fiction without a narrator. For the psy- chotic, the dissolution of a strong
sense of self is a lived reality, and is manifest as suffering. There is little
danger – or even possibility – that those who have such intimate
knowledge of the radical contingency of the `I' could ever retreat behind
the ramparts of a fort-like ego. After journey- ing through the dispersions
of madness, the psychotic is more likely, it seems to me, to adopt, not a
faith in the plenitude of the `I', but something closer to what Jenkins (1996:
18) calls `pragmatic individualism': an awareness that the construct of the
`I' can disintegrate and is contingent, but also a cognizance that in order
to act in a concerted fashion as a sin- gular subject, or to speak in such
a way that one is understood by others and oneself, the adoption of this `position
from which to speak' is vital. Although Hart's and Jefferson's diaries speak
of the everyday, they are not therefore `everyday speech' as Blanchot describes
it; rather, they represent its inverse: self-aware embarkations into language,
which in turn, I argue, comprise willed reconstructions of shattered selfhoods.
50
TEXT
AS EVENT The contemporaneous nature of the writing is key to these journals'
dynamics. Rather than presenting the `story' of Hart's illness, Phone At nine
represents the trace and embodiment of Hart's struggle to speak in a voice
she identifies as `hers' and thereby to resist suffocation and non- being.
Because the entries punctuate the experiences described, they rep- resent
moments of awareness and self-talk that are intercalated into the very business
of living. In the diary, the self is speaking to itself of its own experience,
is verbalizing its existence, with this verbalization interwoven into the
fabric of that existence. Thus, early on in the text, we witness Hart urging
herself not to capitu- late to her father's hostile voice: `Don't listen to
the voice who threatens more depths of despair than I can comprehend' (1997:
6); later, she interposes a textual response: There's a big bad voice saying,
`Your life is over – it won't be long now before you join me in death.
You've got nothing to live for anyway, I've destroyed it all. Your guts are
full of maggots. You are rotting away...'. It's not true. I have my family
and friends to live for. (1997: 194) Such engagements with language and voice
are portrayed as agonistic struggles against the invasive depredations of
the voice of the internalized father. In one particularly powerful expression
of despair, Hart asks: `Where can I be? I can't leave my head somewhere, I
need respite. I need to get away from this fucking voice. The more voice my
father has the less voice I have' (1997: 49). Elsewhere, she links the disintegration
of the embodied self with mutism: Are we flotsam? Washed up like stranded
jellyfish on a beach? No armour, no ribcage, no skull and no spine. Liquid
almost; no defences. Sometimes the surprise of a sting. No voice, though.
No secret whale song to encourage popularity. (1997: 28) This theme of the
effacement of voice recurs when Hart records that the acuteness of her distress
has rendered writing difficult or impossible; such entries again highlight
the contemporaneous nature of the writing, strengthening an impression that
the text embodies an ongoing nego- tiation with a disruptive and chronic suffering.
Thus, the entry for 28 November ends, `Too low to write today' (1997: 29); 15 December: `I can't write any more because I'm crying again'; 14 January:
`I can't concentrate on anything for too long which shows in my writing' (p.
127); 17 January: `Not settled enough to be able to read back over
51
what
I've written recently' (p. 131); 3 May: `I feel too low to write tonight'
(p. 262). Also evidencing the contemporaneity of her writing, in These are
my sisters the reader follows Jefferson's attempts to aid herself. For example,
her assessment of her disturbed cognitive processes proceeds in incremen-
tal steps. First, she acknowledges what currently pertains: `I know I cannot
think straight' (1975: 11); then outlines the implications of this condition:
`Unless I learn to think differently, I shall shortly be insane' (p. 13); arriving at the critical question of what action she can take to change this:
`How – how – how? In the name of God – how does a person
learn to think differently?' (p. 13); and concluding that, despite the diffi-
culty, the task belongs to her: `If I must learn to think differently – there is nothing to do but to go about doing it with what few remaining shreds
of intelligence I have. But how – is the question. It is plainly my
job for none other can do it.' (p. 15). The means on which Jefferson resolves
is writing: `Because I must face the problem and deal with it somehow – I evolved this pen and paper idea' (1975: 24). She then explicitly links her
own continued existence to writing: The flood that was swirling about me was
sucking me under – and the pencil I had in my hand was a straw to be
caught. It was just a straw – but I caught it – and now I have
kept my head above water for a while – even if what I have written
does not make sense to anyone – at least – it has helped me
a little. (1975: 24–25) Explicit here is that while writing has enabled
Jefferson to keep her `head above water', this is by no means an assured or
stable state. As readers we sense that she, like us, is unfolding a story,
the outcome of which she is unsure of. Moreover, the crux of this story is
the effect of its own produc- tion on its author's mental condition. Because
Jefferson chooses writing as the agent of her salvation, the efficacy of this
strategy will be measured within and by the text itself – writing will
measure its own effect. It would be quite possible, indeed, to imagine a different
outcome from Jefferson's eventual return to sanity, one in which her strategies
failed and subsumption by madness was total. THE SOCIAL SELF A critique of
my argument thus far might suggest that the model of iden- tity formation
I am tracing is peculiarly solipsistic, that the troubled self appears to
retreat to its diary, or to its own cognitive recesses, where it begins to
speak to itself and by so doing forms, or strengthens, its sense
52
of (disembodied)
identity. Close study of Hart's and Jefferson's texts sug- gests, however,
that their rebuilding of broken identities is inextricably linked to an engagement
with the social. I have noted that neither journal is marked by a preoccupation
with the self and its own tribulations. This is not to suggest that this critical
con- cern is avoided, but that it is by no means a predominant focus. Rather,
a prominent motif of both texts is an acute awareness of others, of the social,
interpersonal and dialogic dimensions of life both on and off the hospital
ward. Rather than extensively detailing their authors' symptoms, both texts
are preoccupied with other people – hospital staff, other patients,
friends, relatives. Even in their titles this focus is evident: `phone at
nine just to say you're alive' picks up on the injunction placed on Hart as
she begins brief visits home to remain in contact with the ward by tele- phoning
at 9 a.m. and 9 p.m. to report on her state of health; in addition, it invokes
her continual use of the telephone to call friends and family. Both of these
factors situate Hart at the centre of a web of care, an inter- personal network
of others. Similarly, the title of These are my sisters encapsulates the governing
concern of Jefferson's writing: the welfare, behaviour and history of her
fellow patients. Moreover, both texts often take into account and allow for
possible or actual readers. As Hart's writing develops she begins to plan
for and allow staff and friends to read her journal, and her writing is spoken
about by others who encourage her to publish it (before she is released she
learns that extracts will appear in a mental health journal). Her text sometimes
takes the form of a letter to a possible reader, with Hart directly address-
ing others `outside' the text: for instance, she writes to an unnamed reader,
`Let me tell you about the typical routine of the ward' (1997: 100), and concludes
the text with `Thank you, Pat Jenkins, for suggesting I write' (p. 353). Jefferson
also regularly addresses imagined readers outside the text. In addition she
conjures up a textual alter ego and her writing periodically resorts to a
dialogue with this `other'. This is not a manifes- tation of psychosis, but
a conscious strategy which she adopts after a nurse interrogates her about
her writing. The nurse just now picked up one of the sheets I have written.
She read it – looked at me oddly – and asked what in the hell
I thought I was doing. And because she expected an answer in keeping with
my strange occupation [...] I gave her an answer that fitted. I told her that
I was Shakespeare, the reincarnation of Shakespeare trying to sidestep a strait-jacket.
(I'll admit that I feel queer enough to be the reincarnation of something
but I doubt if Shakespeare would claim me). But hurray! She came back down
the aisle with whole ream of paper and said to me: `Go to it, Shakespeare!'
(1975: 25–26)
53
Following
this successful evasion of the medical gaze, Jefferson then wel- comes `Shakespeare'
as an intra-textual reader and companion. Verily, verily, Shakespeare, I had
no idea you could be called from your quiet English grave with so little effort.
In my present predicament, I know of no-one who could be quite such a fortunate
choice for a delusion of grandeur. So welcome! I hope you will be as pleased
with the arrangement as I am. Poor fellow, this is surely a come-down from
your former position. (1975: 26) `Shakespeare' remains as a presence throughout
Jefferson's journal, exert- ing, perhaps, a salutary pull on the introspective
tendency as Jefferson imagines another alongside her, reading her text. At
the close, as she is about to be transferred to a `semi-civilized' (1975:
236) ward, she relin- quishes this strategic other. It is clear that she understands
well the tacti- cal nature of a creation which has enabled her to survive:
`Goodbye William. You were one grand delusion! If you had not come to me,
per- chance this transfer would have been to a place still lower in this limbo – instead of one step upward' (1975: 238). The various interpersonal concerns
and forms manifest in these diaries are crucial to their import, and enrich
an understanding of the way in which the self-fashioning process I have been
arguing for operates. In order to better understand why this is so I will
conclude by considering the work of the Russian psychologist Lev Vygotsky
on the genesis of `inner speech'. VYGOTSKY AND EGOCENTRIC SPEECH In Thought
and language, Vygotsky argues that `inwardness' has an essentially social
nature. He deals at length with the development and con- stitution of `inner
speech', and proposes that the dialogue of the self with the self is a development
from, and remains intimately related to, social, interpersonal speech (here
his theories converge with those of Bakhtin (1984; 1994) and Volosinov (1976)).
Selfhood, therefore, is a boundary phenomenon rather than a privatized realm:
in Vygotsky's words (quoted in Shotter, 1993: 112): `we become ourselves through
others'. Hart's and Jefferson's diaries resemble, I suggest, textual analogues
of one of the key developmental stages in Vygotsky's account of the genesis
of inner speech: the ontogenic precursor to `true' inner speech and what he
calls (after Jean Piaget; see Kozulin, 1986; Ashworth, 1979) egocentric speech.
Vygotsky defines this as a phase in which, from speaking to and with others,
the child begins to speak aloud to itself while in the company of others.
It represents a `transition from speech for others to speech for
54
oneself'
(Vygotsky, 1986: 235); it is a kind of conversation with the self, but one
which `occurs only in a social context' (p. 253), and in which the child assumes
`that his egocentric talk, directed to nobody, is understood by those who
surround him' (p. 231). By arguing thus I am, of course, appropriating Vygotsky's
work in a way which he did not intend. But in the light of Hart's and David's
descriptions of the way in which psychosis radically disrupts any sense that
the inner voice is theirs, it does not seem to me too far-fetched to suggest
that some kind of equivalent process in adulthood may be necessary to achieve
a less painful mode of being. Vygotsky contends that inner speech results
from the incorporation of egocentric speech into the psyche. Whereas egocentric
speech is more or less grammatically complete, and `spoken as an utterance,
that is, as public speech in a specific environment' (1986: 235), inner speech
is marked by a distinctive `tendency towards abbreviation and predication'
(p. 243). Inner speech, therefore, is an intimate distillation of what was
originally egocen- tric, public speech. The condensation is possible because:
We know what we are thinking about; i.e. we always know the subject and the
situation. And since the subject of our inner dialogue is already known we
may just imply it.... Piaget once mentioned that we trust ourselves without
proof; the necessity to defend and articulate one's position appears only
in conversation with others. Psychological contact between partners in a conversation
may establish a mutual perception leading to the understanding of abbreviated
speech. In inner speech, the `mutual' perception is always there, in absolute
form. (1986: 243) Thus, inner speech can be abbreviated because of the certainty
of context: the subject is present to itself in the `absolute form' of `mutual
percep- tion', in that we always `know what we are thinking about'. It is
surely striking, however, that these psychological prerequisites are precisely
what the psychotic lacks. Hart and Jefferson describe psychic economies which
are far less self-assured than Vygotsky implies here. Cast adrift in the turbulence
of psychotic thought, there is a sense in which the subject precisely does
not know, and cannot predict, the direction of her thinking, because the thoughts
appear to come from an autonomous agent. Moreover, it is the lack of trust
in the self which is one of the prime causes of suffering in madness: at any
moment the hostile energies of psychosis may attack the `thinker'. Rather
than facilitating the intuitive `mutuality' of the self-dialogue, the omissions
and ellipses of inner speech may pres- ent spaces and opportunities for the
irruptions of psychotic forms of thought to `enter' and colonize the self.
Thus, to nuance and develop the argument that the diaries represent exercises
in self-talk, and therefore self-reconstitution, we might read
55
these
texts, particularly in the light of their prominent engagement with the interpersonal
realm, as textual analogues of the more complete expres- sions of egocentric
speech: to borrow from Vygotsky, by this means Hart and Jefferson are reforming
shattered identities and `becoming them- selves'. That their `speech' takes
textual form is not surprising given their situations. If these adults hospitalized
with psychotic disorders were to practise egocentric speech by talking aloud
to themselves in the company of others, it would probably be read as pathological
behaviour. (Moreover, psychotics are certainly not immune from social embarrassment,
and there are strong cultural prohibitions against adults talking to themselves
in social situations.) So Hart and Jefferson write, yet their writing is not
a quietist retreat into solipsism but rather is continually inflected by the
interpersonal: they write while in the company of others on their wards; their
writing is understandable by others; they imagine others reading the texts; they address entries to imaginary readers; their texts continually pic- ture
others, and are actually read by others. This focus on, and awareness of,
the social realm is vital for their purpose of rebuilding selfhood, which,
if we follow Vygotsky, is intrinsically bound to and dependent upon the interpersonal.
Moreover, the formulation of complete, grammatically coherent sentences may
operate as a counterweight to psychotic fragmen- tation. Perhaps, with the
sedimentation of egocentric speech and a return to a measure of psychological
health, some `internalization' and abbrevi- ation of self-talk may eventually
be possible, but in the midst of the psychotic storm such a modality of inner
speaking is, it seems to me, impossible. CONCLUSION To recap: I have described
how, in acute distress, human identity disaggre- gates, and I noted the clinical
view that rebuilding a sense of self may ameliorate the suffering of madness.
I went on to describe the arguments of Morin, Baars, Benveniste and Kerby
that the very basis of selfhood is founded in our speech to ourselves; and
with reference to Baars and Blanchot I stressed the experiential difference
between different modali- ties of `speaking'. Finally, Vygotsky's work on
the development of inner speech reveals that what is often taken to be a private,
personal experience is founded in and produced by an engagement with the social.
Perhaps, then, we may begin to understand why Hart and Jefferson make such
startling claims for the efficacy of writing, even though their diaries largely
record the mundane realities of hospital life, and epiphanic moments of understanding
and insight are absent. These texts represent exercises in `voicing', a tentative
`starting to speak', by means of which their authors attempt to re-establish
a salutary relation with the self, and
56
activate
or construct a self by speaking as an `I'. That these reformulations of selfhood
are bound to the intersubjective realm is of particular signifi- cance in
the context of psychosis – which effects a breach with the social world.
Hart, we recall, opens her journal by invoking this separation when she describes
her psychosis as `Taking away my speech, closing me down and taking me away
from the world.' In writing, she recovers her speech, the closed-down self
is reopened, and eventually she returns to the world. Solipsism inheres not
in the self-talk of the journals, but rather in the `morbid introspection'
of madness, as Jefferson (1975: 14) describes it, or, in James Glass's words
(1989: 16), the `isolated realm of the interior monologue ... without any
shared component or audience'. For Jefferson and Hart, writing turns their
gaze outwards, towards the conversations and lives of others. The reformulated
narrative relationship with the self, a relationship, indeed, that is the
self, is thus intercalated into the intersub- jective social realm. The selves
that (re-)emerge in These are my sisters and Phone at nine are radically dependent
on the words, lives and presence of others.
NOTES
1 See Carole North's (1990:
61) memoir of her schizophrenia: `my thoughts sometimes got so hopelessly
jumbled that I needed to write them down for my own comprehension'; and Bonnie
Schell (n.d.: para. 2), also schizophrenic, who describes reading and writing
as `the only order I could feel in the universe ... typing sentences and
editing was my way back to recovery'.
2 Jenkins refers to E.H.
Erikson's study Identity: youth and crisis (London: Faber, 1968) as
support for this contention.
REFERENCES
Adorno, T. 1974: Minima moralia: reflections from damaged life.
Trans. E.F.N. Jephcott. London: Verso.
Ashworth, P.D. 1979: Social interaction and consciousness. Chichester: Wiley.
Baars, B. 1997: In the theatre of consciousness: the workspace of the
mind. New York and Oxford: Oxford University Press.
Bakhtin, M. 1984: Problems of Dostoevsky's poetics. Ed. and trans. C. Emerson. Minneapolis, MN: University of Minnesota Press.
——— 1994: Social heteroglossia. In Morris, P., editor, The Bakhtin reader, London: Edward Arnold, 70—79.
Benveniste, E. 1971: Problems in general linguistics. Trans. M.E. Meek. Miami, FL: University of Miami Press.
Blanchot, M. 1993: The infinite conversation. Trans. S. Hanson. Minneapolis, MN: University of Minnesota Press.
57
Bleuler, E. 1966: Dementia praecox or the group of schizophrenias. Trans. J. Zinkin. New York: International Universities Press.
Caminero-Santangelo, M. 1998 : The madwoman can't speak: or, why insanity is not subversive , Ithaca, NY: Cornell University
Press.
Davidson, L.
and Strauss, J. 1992: Sense of self in recovery from severe mental illness. British Journal of Medical Psychology 65, 131—45.
Derrida, J. 1973: Speech and phenomena and other essays on Husserl's theory of signs.
Trans. D. Allison. Evanston, IL: Northwestern
University Press.
Fabrega, H. 1989: The self and schizophrenia: a cultural perspective. Schizophrenia Bulletin 15, 277—90.
Federn, P. 1952: Ego psychology and the psychoses. New York: Basic Books.
Freeman, T., Cameron, J. and McGhie , A. 1958: Chronic schizophrenia. New York: International Universities Press.
Glass, J.M. 1989: Private terror/ public life: psychosis and the politics of community. Ithaca, NY: Cornell University Press.
——— 1993: Shattered selves: multiple personality in a postmodern
world. Ithaca, NY: Cornell University
Press.
Grossman, R. 2000: Voicelessness: roots, consequences, and cure. Address to the International Moebius Syndrome Conference, Sturbridge, MA, 23 July 2000.
Hart, L. 1997: Phone at nine just to say you're alive. London: Pan.
Helmsley, D. 1998: The disruption of the `sense of self' in schizophrenia:
potential links with disturbances of information processing. British Journal of Medical Psychology 71, 115—24.
Jaspers, K. 1962: General psychopathology. Trans. J. Hoenig and
M.W. Hamilton. Manchester: Manchester University
Press.
Jefferson, L. 1975: These are my sisters: a journal from the inside of insanity . London: Victor Gollancz.
Jenkins, R. 1996: Social identity. London: Routledge.
Kerby, A. 1991: Narrative and the self. Bloomington,
IN: Indiana University Press.
Kozulin, A. 1986: Vygotsky in context. In Vygotsky, L., Thought and language, Ed. A. Kozulin; trans. E. Hanfmann
and G. Vakar, Boston, MA: MIT Press , iv—lvi.
Levin, D. 1987: Clinical stories: a modern self in the fury of being.
In Levin, D., editor, Pathologies
of the modern self: postmodern studies on narcissism, schizophrenia, and depression , New York: New York University
Press, 479—538.
Mann, D. 1991: Ownership: a pathography of the self. British Journal of Medical Psychology 64, 211—23.
Morin, A. 1993: Self-talk and self-awareness: on the nature of the relation , Journal of Mind and Behavior 14, 223—34.
——— 1995a: Characteristics of an effective internal dialogue in
the acquisition of self-information. Imagination, Cognition
and Personality 15, 45—58.
——— 1995b: Preliminary data on a relation between self-talk and
complexity of the self-concept. Psychological Reports 76, 267—72.
——— 2003: Inner speech and conscious experience. Science & Consciousness Review, 4.
Retrieved 1 August 2004 from <http://www.sci-con.org> [electronic
journal].
58
Morin, A.
and Everett, J. 1990: Inner speech as a mediator of self-awareness, self-consciousness,
and self-knowledge: an hypothesis. New Ideas in Psychology 8, 337—56.
North, C.S. 1990: Welcome, silence: my triumph over schizophrenia. London : Arrow.
Sass, L.A. 1998: Madness and modernism: insanity in the light of modern art, literature, and
thought. Cambridge, MA: Harvard
University Press.
Saxe, G., van der Kolk, B., Berkowitz, R., Hall, K., Lieberg, G.
and Scharz, J. 1993: Dissociative disorders in psychiatric inpatients. American Journal of Psychiatry 150, 1037—42.
Schell, B. n.d.: Why we have
creative writing at MHCAN. Mental Health Client Action Network. Retrieved
13 November 2003 from <http://www.mhcan.org/
writing/bonywhy.html>.
Shotter, J. 1993: Cultural politics of everyday life: social constructionism, rhetoric and knowing
of the third kind. Buckingham: Open University Press.
Spitzer, M. 1990: Ichstorung. In search of a theory. In Spitzer, M. and Maher, B.A.,
editors, Philosophy and psychopathology, New York : Springer-Verlag, 167—83.
van der Kolk, B. and van der Hart, O. 1995: The intrusive past: the flexibility of memory and the engraving of trauma . In Caruth, C., editor, Trauma: explorations in memory. Baltimore, MD
and London: The Johns Hopkins University
Press, 158—82.
Volosinov, V.N. 1976: Freudianism: a Marxist critique. Trans. I.R. Titunik. New York: Harcourt Brace.
Vygotsky, L. 1978: Mind in society: the development of higher psychological
processes. Ed. M. Cole. Cambridge, MA: Harvard University Press.
——— 1986: Thought and language. Ed. A. Kozulin; trans. E. Hanfmann and G. Vakar. Boston,
MA: MIT Press.
Young, R. 1995: Whatever happened to human nature? Sheffield: University of Sheffield. Retrieved 1 August 2004 from <http://www.shef.ac.uk/~psysc/ human/chap1.html>.
NOTE
ON CONTRIBUTOR
BRENDAN
STONE is a Teaching Fellow in the Department of English Literature at the
University of Sheffield. His Ph.D. was entitled `Starting to speak: madness
and the narration of identity' and focused on the ways in which individuals
living with chronic distress employ narrative to nego- tiate and construct
a sense of selfhood. His other research interests include trauma and its representation; memory and narrative identity; and the intersections between fiction and autobiography.