Maria Patsou reviews Performance, Medicine and the Human by Alex Mermikides (Bloomsbury Methuen, 2020).
Alex Mermikides’ book Performance, Medicine and the Human (2020) is a transdisciplinary enquiry into medical performance, a term borrowed from Philip Auslander’s work on modernism, post-modernism and performance (1997) and Petra Kuppers’ work on medical performance (2007). Mermikides also uses the term pathographic performance(established by Brodzinski, 2016) to denote ‘a subgenre of pathography’ and ‘performance based on autobiographical accounts of illness and medical treatment’ (Mermikides 2020: 26). Through her study, Mermikides examines the concepts of the human and the posthuman, elusive in nature not least because their definition is rooted in so many differing disciplines. Here she locates them in performance and medicine, due to the two disciplines’ ‘shared preoccupation with the human and humane’ (2). Mermikides acknowledges the challenges of tackling the concept of the posthuman in her introductory chapter, via theories that range from anthropocentrism in philosophy, cultural and historical studies, to cybernetics and virtual reality, and across popular and academic discourse (11-4), while the human is defined principally in relation to medical methods that inadvertently dehumanise (16). Four thematic chapters bring together examples from Mermikides’ own production company Chimera and other performances with case studies from medical research and practice. Extracts from the author’s diary used as interludes, give the book a semi-autobiographical tone. The inventive narrative arrangement switches effortlessly from analysis to performance text, keeping the reader alert and engaged. This structure – idiosyncratic and complicated – is fitting for the subject matter, hinting at the challenges of marrying together two seemingly contradictory fields.
‘Is our attention upon the cell or the soul?’ (2020: 1) asks Mermikides in the opening passages of the book, raising an important question that strikes at the heart of medical humanities scholarship. Mermikides establishes that her book is about medical experience and encounter, often focussing on the process of treatment and the encounter between clinician and patient (9). From early on, the author raises the question of authenticity: this is particularly pertinent when it comes to medical performances that are based – to a degree – on autobiographical material. This is an area of enquiry that would benefit from further research, building on the existing scholarship of authors like Deirdre Heddon, who has written on autobiographical performance by Bobby Baker and the late Adrian Howell, amongst others, with well-known monographs such as Autobiography and Performance (2008). In this sense, Mermikides’ contribution is an urgent one. Through her introduction, Mermikides draws parallels between performance (medical-themed and otherwise) and medicine, and connects medical performance with humanity and the qualities of the post-human. Performativity and authenticity are established as key concepts. Mermikides explains performativity as the ability of medical performance to change, a shift in those involved and the surrounding audience (4) and ‘a certain concept of the human that is enacted’ in performance (26). By establishing this network of intertwined concepts, the author examines the idea that if everything we do entails some degree of performance or can be explained by acting or enactment, then inauthenticity is put into question. Authenticity as we will see later, will be examined in relation to the qualities of the medical profession, more particularly through the question of personality attributes versus skills when it comes to professional care delivery.
The next chapter “Gazes and Stages: Looking at Bodies in Theatre and Medicine” treats the positioning of audience/performer as analogous to that of patient/clinician. Mermikides’ treatment of these alleged binaries is a dance, at times elegantly choreographed and at times awkward, reflecting how these relationships are shaped in their respective settings. The exploration of the role of the audience highlights surveillance and exhibitionism as significant concepts for both theatre studies and medical humanities. Mermikides succeeds in digging out unexpected points of similarity and interaction between these two fields, using the observation of bodies in performance and in medicine (with the audience playing doctor, so to speak) as a starting point, and putting the ‘theatrical gaze’ in parallel to the ‘medical gaze’ (rather that setting one above the other in a hierarchical relationship) (2020: 32). Within this context she highlights the literal position of audience and actor in classical theatre venues as reminiscent of anatomy theatres and reflecting the ‘Cartesian subject’ (35), i.e. the split between body and soul, ultimately arguing that they are more connected than we think. The dualities examined here are the first of many.
The following chapter, “Playing Doctors: Performing the ‘Humanistic Physician’” is concerned with medical simulation (in the context of medical training) as performance, and focusses on the concept of empathy, one of the ‘bastions of first-wave medical humanities’ (Mermikides 2020: 63) and ‘an icon of the growing medical humanities movement in the USA and the UK’ (Macnaughton 2009). This chapter gives a thorough account of medical training in breaking bad news to patients, with a focus on the performativity of the clinical exchange. Mermikides approaches empathy as a not-always-helpful term for framing the clinical encounter, noting that it ‘risk[s] perpetuating rather than countering the asymmetry of the medical encounter’ and proposing that ‘a posthumanist viewpoint might more radically challenge the humanistic values that surrounds the doctor’s role’ (63). The author details numerous occasions where medical training focuses on how to exhibit empathy rather than actually feel it, and challenges traditional ideas about the ‘innate’ caring qualities that healthcare staff are supposed to hold in order to be considered good in their role, highlighting the language around empathy used in training (e.g. ‘empathic responses’ (68), ‘convey empathy’ and ‘showing your empathy’ (69)). This is one way of exploring the idea of a human that is performed.
In the chapter “Chimeric Bodies: Posthuman Selves in Medical Performance”, Mermikides examines conceptions of the human through her own performance-making, specifically the performance bloodlines, which developed out of clinical conversations about her brother’s leukaemia and her experience as a successful bone marrow donor. Here, Mermikides uses the ‘otherness of disease’ (2020: 90) as an opportunity to examine the split between self and other in illness. As the chapter is extensively dedicated to the scientific ‘us’ (the human through the eyes of science), Mermikides asks ‘to what extent is the individual self unique to a singular body?’ (88). The author examines the dislocation that comes both for donor and receiver in an attempt to examine ‘”chimeric” – conceptions of the embodied self’ (91), using cancer (an illness that comes from our own body) as an example to assert whether disease is something that can be viewed as other. This is a particularly relevant argument in certain psychiatric diagnoses that are often misconstrued as part of someone’s personality, such as Personality Disorders (APA 2013: 645-84), with research in more recent years addressing their presumably stable relationship with personality traits (Warner et al. 2005) and continuing to pose various diagnostic and treatment challenges. This chapter sees the ‘chimeric’ collapse of dualities (110), a fitting outcome for any transdisciplinary field aiming to unveil elements of what constitutes the posthuman through the meshing of bodies.
In her ultimate chapter, “Taking Care: Cultivating Passion in Nursing and Applied Performance” Mermikides picks apart her production Careful in order to analyse further the relationship between self and other as a paradigm to understand human and posthuman; care and empathy as skills vs innate characteristics; and care ethics. Careful is based on experiences from the nursing profession. As the performance was preceded by a workshop with nurse students and the intention behind the project was to deliver a number of learning outcomes from the students, the author seizes the opportunity to evoke applied theatre principles. Applied practices refer to a theatre that has traditionally come to mean participatory theatre in specific contexts such as educational settings, hospitals or prisons, with certain desired ‘results’ in mind for those participating and attending, but which, in more recent years has been contested as to how much it can embody (Thomson 2009: 3). Mermikides also refers to arts and health or arts in health principles, an equally broad term that typically defines art activities for service users taking place in clinical settings: arts and health gained prominence in the UK in the 1980s and promotes the idea of art provision for the sake of better health. Here Mermikides draws again from interconnected fields of direct relevance to medical performance and examines ‘compassionate care’ (2020: 121), a concept more pertinent than ever during the pandemic, where healthcare staff are faced with extraordinary demands. To what degree is compassionate care applicable when healthcare staff strive for literal and figurative survival? Mermikides examines the expectations by this profession in the light of the Francis Report (2013) that disproportionally placed blame on nursing stuff for Trust-wide failures.
If I had one criticism to make, it would be in relation to the absence of mental health as part of medical and pathographic performance. There is also no clear indication or explanation as to why the subject of medical performance in this case is performance that is predominantly about physical illness and as the introduction is so good at establishing what this book is, about it feels like a missed opportunity not to include a rationale on the absence of mental health. Here, the medical is equated to the physical. Those who are familiar with Mermikides’ performance-based work will be aware that her expertise is on the physical dimensions of illness. Perhaps the reason for its absence is exactly this, that mental illness ‘plays’ on a different level and the discourse is inevitably separate, and as much as we may wish to view mental illness under physical illness terms in order to de-stigmatise it, its absence in this study is one more proof of the complexity of the mental illness debate.
Mermikides achieves, to a great degree, the aim of examining the relevance of performance to medicine and the concept of post-human without losing sight of wider and micro-aims, such the debate between skills and personality as attributes in the healthcare profession. Such discussions lie at the core of medical humanities since the establishment of the field, and they are likely to be debated for years to come.
Maria Patsou is currently completing a PhD in mental illness and theatre performance at Birkbeck College. She has previously worked as a researcher and practitioner in the fields of health, arts and museums.
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Auslander, Philip. 1997. From acting to performance: Essays in modernism and postmodernism. London and New York: Routledge.
Brodzinski, Emma. 2016. The Patient performer: Embodied pathography in contemporary productions. A. Mermikides and G. Bouchard (eds). Performance and the medical body, London: Bloomsbury Methuen Drama, pp. 85-98.
Francis, Robert. 2013. The Mid Staffordshire NHS Foundation Trust Inquiry. London: The Stationery Office. https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry(accessed July 7, 2021).
Heddon, Deidre (2008). Autobiography and Performance. Hampshire and New York: Palgrave Macmillan
Kuppers, Petra. 2007. The scar of visibility: Medical performances and contemporary art. Minneapolis: University of Minnesota Press.
Macnaughton, Jane. 2009. The art of medicine: The dangerous practice of empathy. The Lancet: Perspectives, 373 (9679): 140-1.
Mermikides, Alex. 2020. Performance, Medicine and the Human. London and New York: Methuen Drama.
Warner, Megan B., Morey, Leslie C., Finch, John F., Gunderson, John G., Skodol, Andrew E., Sanislow, Charles A., Shea, M. Tracie, McGlashan, Thomas H., and Grilo, Carlos M. 2005. The longitudinal relationship of personality traits and disorders, Journal of Abnormal Psychology, 113 (2): 217-27.
Thompson, James. 2009. Performance affects: Applied theatre and the end of effect, Hampshire: Palgrave Macmillan.