Wendy Lowe reviews Anna Harpin’s Madness, Art, and Society: Beyond Illness (Routledge, 2018).
Madness, Art and Society provides a comprehensive account of Anna Harpin’s ways of looking at and critiquing the practices of diagnosis and treatment of madness through numerous examples of art and mental healthcare. The book is a rich analysis of how madness is experienced, treated and represented with sensitive discussion of the materials. Madness, Art and Society opens with a discussion of how the use of art can enrich the dialogue between the biomedical model of mental health and the medical humanities. Harpin achieves this by moving away from an ontological model of mental ill-health to one that is more experiential, relational and generative. In doing so, Harpin hopes to move away from the myth of a ‘cure’ to instead enable a dialogue on how to live with and through one’s felt and experienced orientation.
After the introduction, Madness, Art and Society divides into two parts. Part One reviews key figures and locations in the care of madness. Part Two explores questions of how we know what we know through an analysis of different experiences. Through poignant pieces on different realities, bodies and moods, Harpin opens a dialogue between biomedical and experiential perspectives. I really enjoyed the careful account of key historical figures and institutions along with a review of some types of treatment. In Chapter Two Harpin turns from key figures involved with diagnosis and treatment of schizophrenia to how artists figured these clinical spaces in mental care contexts and practices. There is the imperative that these diagnoses and treatments cannot be separated from the socio-cultural milieu in which they take place. The author emphasizes the role of language in the social and medical execution of difference, using beautiful phrases such as ‘the quivering thresholds of normalcy’ (45); crossing the threshold from an asylum to the community has also, according to Harpin, ‘meant poor or non-existent care, ghettoization, social isolation and homelessness’ (49). This is a keen analysis of policy and rhetoric within the field. There are some real gems here including a discussion on learning lines (62), wilfulness (63) and living with and through madness (78).
The section in Chapter Three on illness categories in response to the availability of medication demonstrates how mental illness is created as much as it is discovered, within the biomedical model. The questions asked about what constitutes a valuable life remind me of Judith Butler’s book on giving an account of oneself on how to have a liveable life. Butler’s perspective is that sometimes these accounts are non-narrativisable except perhaps in the dialogue of living with and through the experience. Butler (2005) believes that giving an account of oneself and thereby having an ethical approach to life is not possible without a turn to the social conditions under which one acts. She argues that having a transparent, rational and continuous ethical subject is an impossible construct which can only deny the experience of what it is to be human. This section is particularly relevant to the recent upsurge in interest and protest about treatment regimes that have proven addictive, damaging and given in the blind hope that they will enable the recipient to have somewhat of a more liveable life than without them.
Part Two moves on to exploring the experiences of madness and thus away from the biomedical model. Through different genres, the author explores ‘tuning in’ (110) along with questions of truth and reality. The synergies between art and lived experience are emphasized in order to find different ways of thinking about mad subjectivity. The section on women’s bodies, food and eating is a welcome addition to the field of ‘fat studies’ and women’s appetites with the lens of art and theatre. The last chapter is a really interesting exploration of mood through all its delineations that invites different ways of knowing that are politically urgent. This is a fascinating section that will provide food for thought for a long time to come.
I especially appreciated the approach of tenderness as a way of being with vulnerability, risking rejection, which admits the thresholds of difference whilst running counter to resilience discourses. Harpin offers tenderness as a conceptual gesture towards her subject:
The recurrent understanding of tenderness as involving an offer, a stretch, a holding-forth reminds us that tenderness is an intersubjective dialogue. Moreover, it is not a certain gesture. To be tender or to tender is to make an offer without assurance of its reception. .. tenderness is vulnerable. It risks rejection (10).
In this way, Madness, Art and Society, in a hopeful gesture, offers a generous embrace of distress and alterity. On the subject of distress, there could have been a section on how poverty distress is often individualised and medicalised within the biomedical model as a sign of madness, rather than it being seen for the contextualised experience of perhaps more socially determined difference. Notwithstanding this, by being concerned with what madness wants and needs, or desires, rather than what it is, Harpin is able to maintain fluidity with her subject matter. These differences from traditional texts on madness provide a novel way of thinking about madness, art and society.
Overall, this is a carefully written, tender exploration of madness through art and society that draws on unique conceptualisations and thereby offers the reader a different window to explore their own and the social strictures and structures of madness. Anna Harpin has written a painstakingly detailed exploration of both the biomedical and experiential models of madness. This exploration invites further dialogues between these two by pointing to a portal of vulnerability and humility. I heartily recommend Madness, Art and Society as one to be savoured over many (winter) evenings, with plenty of space to digest the rich offerings written in such a tender way as to be a strong resource in this field.
 Judith Butler, Giving an account of oneself. (Fordham University Press: New York, 2005).
Wendy Lowe is a Senior Lecturer in Medical Sociology and Medical Education, Module Lead for the Human Science Public Health module in Years 2 and 3 of the MBBS and GEP at Barts and The London School of Medicine and Dentistry. Her PhD explored how health professionals are educated.