Making Space for the Patient’s Voice: notes from a creative writing workshop (part 1)

Jane Hartshorn writes:

In November 2020, I facilitated a creative writing workshop as part of Thinking Through Things: Object Encounters in the Medical Humanities, a collaborative project developed by a team of ECRs from across the NNMHR and funded by a Wellcome Trust Discretionary Award.

The workshop was a collaboration between myself and writer Gillian Shirreffs. Drawing upon our doctoral research, creative practice, and lived experience of chronic illness, our intention was to deliver a two-part workshop that explored ways to make space for the patient voice.

In Lost Bodies (2006, 21), Laura Tanner writes that ‘in the examining room, the person with illness becomes the white space in the picture, the absence which allows the illness to be seen’. As a patient myself, I recognise this feeling of erasure, of being a medical specimen under the gaze of the clinician, rather than a person with an identity and a history. It was this notion of depersonalisation, of the transition from active subject to medical object that I hoped to interrogate within the workshop.

Jean-Martin Charcot demonstrating hysteria in a hypnotised patient at the Salpêtrière. Etching by A. Lurat, 1888, after P.A.A. Brouillet, 1887. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

I selected images from the Wellcome Collection archive that featured patients in examining rooms. I specifically chose representations of women because I wanted to explore the possible tensions and resonances between the objectification of the patient body by the medical gaze and the objectification of the female body by the male gaze.

I primarily chose images that depicted the medical encounter – that were situated within a hospital or surgery, and included the presence of medical practitioners. I selected these images because I thought they might provide insight into the imbalance of power in the patient/doctor dynamic, and the role gender plays within this relationship.

However, I soon fell into difficulty, as it became apparent that some of the women may not have given their consent to be portrayed. As well as this, I struggled to reconcile how I could weave a creative writing exercise into such ethically dubious territory, without enacting a similar kind of violence upon those who had already been objectified and disempowered.

For example, a photograph titled ‘Female patient with hysteria-induced narcolepsy’ features an unnamed young woman lying in a hospital bed with her eyes closed. She faces the camera, her mouth slightly open, her arms bound to her chest by a straitjacket. It is impossible to know if she voluntarily admitted herself to the hospital, or if she was incarcerated against her will, yet the presence of the straitjacket infers a measure of physical restraint.

The photograph was taken between 1878 and 1910 by Albert Londe, an influential medical photographer known for his work at the Salpêtrière, a hospital for the treatment of those living with mental illness, and (in)famous for the unethical methods of its senior physician Jean Martin Charcot.

My intention was to include the image as an example of someone who has been objectified by the medical gaze, however, following a conversation with my co-presenter Gillian Shirreffs, I decided to cover the woman’s face with a white rectangle. As the woman clearly hadn’t given consent to be photographed, I did not feel it was ethically sound to include the image in its entirety. On reflection, I think it may have been better to describe the image to the participants, as I can’t help but think that even my partial inclusion of the image perpetuated the exploitation of the woman depicted.

As I presented the images, I asked participants to consider the following questions:

Do you think the images accurately represent what it might be like to have an illness?

Do you think the images accurately represent what it might feel like to be a patient within the medical encounter?

Within the ensuing discussion, it was mentioned that many of the women were depicted in passive, supine positions, with their eyes closed. They were often naked, with idealised bodies, and placed in poses of exaggerated femininity. For example, in a 1912 watercolour by the artist Richard T. Cooper, a woman lies naked on a bed, the top half of her body visible. In a pose reminiscent of Henry Fuseli’s ‘The Nightmare’ (1781), her left arm covers her face; her right arm is flung to the side. Although this is a representation of the surgical treatment of breast cancer, the woman depicted could be in the throes of ecstasy, rather than pain. Describing the female nude in European art, John Berger (2001, 14) writes that, ‘[h]er nakedness is not a function of her sexuality but of the sexuality of those who have access to the picture’, and I think this is certainly true of this particular image; rather than provide an accurate representation of surgery, it seems that the painting’s function is to titillate the viewer.

As the images I’d taken from the archive were all from the perspective of an observer – looking from the outside in – I decided to include depictions of illness made by patients themselves, as a means of providing a more accurate insight into the lived experience of illness.

Within the collection, I found a number of self-portraits by the photographer Jo Spence. I presented the participants with two of these – the first was taken in 1982, and the second in 1992, shortly before Spence passed away from cancer. In the first image, Spence is topless and the words ‘Property of Jo Spence?’ are inked across her left breast. Spence made the photograph after a negative interaction with a doctor who marked her breast with a cross without permission. As Spence recounts, ‘I heard this doctor, whom I had never met before, this potential daylight mugger, tell me that my left breast would have to be removed. Equally I heard myself answer, “No.” Spence responds to this ‘daylight mugging’ by claiming ownership of her body; she refuses to have a full mastectomy and instead opts for a lumpectomy.

Both images and text are from Spence’s project with Terry Dennett, The Picture of Health (1991-92). Spence was diagnosed with breast cancer in 1982, and The Picture of Health not only serves as a record of her ailing health, but is also a political enquiry into the failings of the medical establishment. Within the project, she writes:

Just as women’s bodies are fragmented (particularly in advertising and pornographic images) so they are within orthodox medicine, where signs and symptoms are treated within an impressive range of specialities but seldom is account taken of the whole body, or lifestyle of the patient.

Spence’s reference to the fragmentation of women’s bodies both by visual culture and medical care finds its echo in Laura Mulvey’s essay ‘Visual Pleasure and Narrative Cinema’ (1975, 17). Mulvey describes how patriarchal society has shaped visual culture in such a way that images of women are ‘(passive) raw material for the (active) gaze of man’; I think her argument is applicable to the medical encounter, where the patient becomes the passive object of the clinician’s active gaze.

Moving towards the creative component of the workshop, I introduced the participants to a series of extracts from poems that document the patient’s transition from subject to object. For example, in Sylvia Plath’s poem ‘Tulips’ (1966, 10), she describes the loss of agency she experiences as a patient: ‘I have given my name and my day-clothes up to the nurses / And my history to the anaesthetist and my body to surgeons.’ The ‘I’ of the poem is fragmented by the medical encounter; the nurses, anaesthetist, and surgeons all receive disparate parts of her.

Similarly, in her poem ‘incantation, overheard in hospital’ (2012, 300), Lucille Clifton recounts how her cancer diagnosis transforms her from speaking subject to automaton: ‘[…] she will / follow you she will / do whatever you say’. Rather than writing from the position of a cohesive ‘I’, Clifton’s third person evokes her out-of-body experience at the hands of medical practitioners, as she ‘become[s] her own ghost.’

Anne Sexton’s ‘The Operation’ (1999, 56) speaks of ‘the great green people’, and how she, too, ‘follow[s] their command / to curl, head touching knee if I am able.’ Sexton embodies the role of the ‘good’ patient, docile and compliant. ‘Next, I am hung up like a saddle’ conveys her experience of herself as an object under the medical gaze. In a mirror image of Clifton’s ‘ghost’, Sexton ‘[p]ale as an angel […] float[s] out over [her] own skin’ a reference to the dissociation often experienced during these kinds of invasive procedures.

Sexton also describes the ‘oily rape’ of the glove of the doctor who is examining her. By drawing upon the imagery of sexual violence, Sexton demonstrates how, in its penetration of the body, medical examinations can be experienced as a violation. Similarly, in her poem ‘Cuts’ (2019, 49-50), Tamar Yoseloff compares the female surgeon’s fingers to

the men who made

their marks, clumsy fingers sometimes

hard enough to shape a bruise,

a purple tag of conquest that faded

just as they did.

Like Sexton, she draws a comparison between medical and sexual encounters. However, in this case, ‘[t]he surgeon’s finger is light / on [her] skin, softer’ than those of the men who attempted to dominate her.

Yoseloff proceeds to include details of Yoko Ono’s 1964 performance work ‘Cut Piece’, again invoking the language of sexual violence to describe the scene. For example, the man ‘mounts’ the stage, and ‘bones’ Ono like a bird. For Yoseloff, this surrender to male dominance or violence finds its parallel in the medical encounter. She loses her agency, writing of how the consultants ‘handle’ her as though she is an object, and describes herself as ‘a piece of meat’. ‘It’s not happening to me’ points to the dissociation as coping-mechanism that is necessary for such encounters. In the same way that Ono ‘offer[s] her body to strangers’, Yoseleff ‘sacrifices herself’ – abdicating her body and thus relinquishing her agency.

Patient bed space on a UK hospital ward. Credit: Adrian Wressell, Heart of England NHS FT. Attribution 4.0 International (CC BY 4.0)

The workshop ended with a creative writing exercise. I had originally contemplated setting an ekphrastic exercise, as a gesture of care towards those who had been pathologised and diminished by the medical gaze. However, I was aware that inventing an emotional history for the women in the images could be considered a further violence or erasure, and on reflection, I decided that it would be harmful to do so.

Instead, I decided to provide a new image from the collection – of an empty hospital bed. I asked participants to respond to the image in a way that treated the patient as a subject, rather than as an object. I gave participants the option of writing from the perspective of the doctor/nurse, or of an onlooker/family member/friend, as I thought that given the subject matter of the presentation, some participants may feel uncomfortable writing from the perspective of the patient. I also assured participants that their writing need not be an account of severe or debilitating illness, if this was beyond their own experience. Instead, it could be based upon their experiences of visiting a GP or dentist for routine examinations.

For those who needed help with a place to start, I suggested taking a line or two from one of the excerpts – for example, ‘I have given my name and my day-clothes up to the nurses / And my history to the anaesthetist and my body to surgeons’ from Plath’s ‘Tulips’. The workshop ended with participants sharing examples of the creative work they had produced.

Although I have facilitated creative writing workshops in the past, this particular workshop was a significant learning curve for me, as it raised so many questions regarding the ethics of including images of patients within the context of a discussion or workshop. It made me consider my own role as facilitator, and the responsibility of care I owe towards those who have been objectified and anonymised by the medical gaze.

References

Berger, John. 2001. “Past Seen from a Possible Future”, in The Selected Essays of John Berger, edited by Geoff Dyer, 7-23. London: Bloomsbury.

Clifton, Lucille. 2012. “incantation, overheard in hospital”, in The Collected Poems of Lucille Clifton 1965-2010, edited by Michael S. Glaser and Kevin Young. Rochester, NY: BOA Editions, Ltd.

Mulvey, Laura. 1975. “Visual Pleasure and Narrative Cinema”. Screen Vol.16, Issue 3 (October): 6-18

Plath, Sylvia. 1966. “Tulips” in Ariel. New York: Harper & Row.

Sexton, Anne. 1999. “The Operation” in The Complete Poems: Anne Sexton. Boston: Houghton Mifflin.

Spence, Jo. “The Final Project” in Misbehaving Bodies: Jo Spence and Oreet Ashery, 30 May 2019—26 January 2020. Wellcome Collection, London

Tanner, Laura E. 2006. Lost Bodies: Inhabiting the Borders of Life and Death. Ithaca, NY: Cornell University Press.

Yoseloff, Tamar. 2019. “Cuts” in The Black Place. Bridgend: Seren Books.

*****

Jane Hartshorn is a poet, editor, and PhD candidate at University of Kent. She is poetry editor at Ache Magazine, and her poetry publications include Tract (Litmus Publishing, 2017) and In the Sick Hour (Takeaway Press, 2020). @jeahartshorn

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