Mad and Bad: Lewis, Psychosis and the Culture of Psychiatry

Alan Munton

David Trotter, Literary Experiment, Psychosis, and the Professionalization of English Society (Oxford: Oxford University Press, 2001), 358pp. £35.00 ISBN 0 19 818755 6

 
I once asked a practising psychiatrist if he or his colleagues ever referred to their patients as mad. ‘I’m afraid we sometimes do’, he replied.  David Trotter has fewer inhibitions.  A professional literary critic who now holds the senior professorship in the profession of literary studies in Britain (the King Edward VII Professorship at Cambridge), he feels able to assert that the modernist authors he discusses ‘wrote about madness and went a little mad themselves’. (7-8)  Trotter’s madmen are Joseph Conrad, Ford Madox Ford, T.E. Hulme, D.H. Lawrence and Wyndham Lewis.  They are all mad in different ways, though Lawrence, who held views which most readers would think strange, is the sanest amongst them, and the quiet hero of this book.  Paranoid Modernism climaxes dramatically with the case of Wyndham Lewis, who of course turns out to be monumentally mad.  Trotter diagnoses most of his subjects as paranoid, but Lewis is schizophrenic as well.

            Yet—and surely this is an inconsistency?—Lewis understands madness as well, for the debate at the end of The Childermass is ‘his attempt to redeem it [the afterworld] from schizophrenia—to restore a measure of paranoid modernism’. (350)  This suggests that paranoia is normative; it is certainly offered as preferable to schizophrenia.  Yet at other times Trotter writes as though any kind of madness is deplorable, and there is a persistent sense that his modernists are not only mad, but bad as well.  This cannot follow, for illness is illness, and in itself neither good nor bad.  If madness means badness, there is probably be something wrong with the argument as a whole.  The decision to use ‘paranoia’ and ‘schizophrenia’ as an antithetical pair in either/or structures, as in the example just given, rules out the combined term paranoid schizophrenia, which describes the form of mental illness most common in the psychiatric discourse that Trotter has chosen to work with.  The paranoia/schizophrenia bipole notably fails when it is applied, in a major instance, to a text by Lewis.

            ‘If we were to attach a psychosis to these descriptions, it would be schizophrenia, rather than paranoia’, Trotter writes. (349)  In the descriptions chosen Lewis uses a neologism, a ‘lunge at meaning’ which resembles the word-invention present in schizophrenic patients, and this means Lewis is, in some substantial sense, schizophrenic.  This is so because ‘Bleuler regarded neologism as an “accessory” symptom of schizophrenia’ (348)  It was Eugen Bleuler (1857-1939) who in 1908 first presented the world with the term schizophrenia, meaning a splitting of the mental functions; Trotter relies upon Bleuler’s symptomatology to argue that there is schizophrenia in The Childermass. 

            Wandering abroad in the afterworld, Satters undresses and runs naked towards Pullman.  The words ‘cloppers up’ are the ones that matter here: ‘A formidable elongated bladder of meat, Satters cloppers up his arms flapping fin-like as he runs, useless paddles of dough beating the air up into invisible suds’.  Trotter makes two false assumptions, the first that ‘cloppers up’ is transitive, ‘so that Lewis takes a very rough stab at whatever it is that Satters does with his arms’.  Next, he assumes that ‘clopper’ is a neologism that alters ‘clobber’ or ‘running like the clappers’  It is, Trotter concludes, ‘Lewis’s near-miss, the word he needs for something he cannot quite say’, just as schizophrenics in their madness invent words for important but elusive concepts, and ‘“Clopper”....is a schizophrenic word’. (348)  Lewis is defined as mad because he has written in the way that a schizophrenic speaks.  This is what it means to ‘attach’ a psychosis to a piece of text.

            What Trotter perhaps does not know is that Lewis was fond of searching out unusual words in dictionaries, making lists of them, and incorporating them into his fiction.  He has done that here.  ‘Clop’ is to be found in the Oxford English Dictionary, and if Lewis did not find it there he could have drawn upon his knowledge of colloquial French, for ‘clop’ is related to clopiner; indeed, clopiner vers, which is current French, translates ‘cloppers up’.  The word means ‘to hobble’ and the example in OED (‘rare’) is quite recent: ‘I took my stick and clopped away down to the White Hart’ (1863).  The contemporary poet Tom Raworth also uses the word.[1]

The phrase ‘Satters cloppers up’ means that he hobbles towards Pullman.  Lewis’s use is not transitive, and it is not his arms that Satters cloppers up.  The absence of a comma after ‘up’ no doubt makes the reading difficult.  Lewis’s usage may be unusual, but it is precise, and not a ‘schizophrenic’ near-miss at all.

            This interpretative blunder shows how very difficult it is to substantiate the psychiatric reading of a text.  The general argument too is suspiciously weak.  Why so few examples?  What psychosis would Trotter attach to Finnegans Wake, where dozens of neologisms are to be found on every page?  Joyce would surely be diagnosed as utterly and irretrievably insane, but Finnegans Wake, an inescapable point of reference, is nowhere mentioned.  Joyce is saved from a humiliating diagnosis because he has become (in Dennis Brown’s words) ‘the revered super-modernist’,[2] critically untouchable and consequently untouched by madness. 

            I have been careful to specify that the author of Paranoid Modernism is attempting a psychiatric reading of modernism.  That emphasis is a fresh one in literary criticism, where psychoanalysis has been the preferred theory.  The move is potentially interesting, but faces great difficulties.  Freud worked within a rich and varied intellectual culture which provided him with his interpretative terms (Oedipus), or his objects of enquiry (Leonardo), or his mode of argument, the essay or short story.  His texts are open to reinterpretation precisely because they deal with neurosis rather than psychosis, for Freud wisely kept clear of the truly mad.  Neurosis occurs within culture, psychosis ends up (at its worst, and all too often) in the hospital ward.  Trotter’s attempt to find a cultural application for psychiatry runs up against the difficulty that psychosis is recalcitrant to interpretation.  Schizophrenics often interpret the world idiosyncratically and, at the height of their illness at least, may endure a sharp reduction in the ability to relate to others or to express themselves either coherently or at all.  Loss of affect is one symptom of schizophrenia, and patients may be reduced to a relationship circle of nurses, doctors and therapists, often in an institutional environment where their behaviour is stabilised by drugs.  Psychoanalysis works in a different world.  ‘Dora’ first contradicted Freud, and then walked out on him, privileges of the merely neurotic.  A diagnosis of schizophrenia may have consequences in law that can remove patients from participation in the world at large.  (In Britain they may be ‘sectioned’ under Sections 2, 3, 4 or 5 of the 1983 Mental Health Act.)  The mind ‘gone’, the body too may be removed from culture.  Trotter knows how serious schizophrenia can be—‘schizophrenia is meltdown’ (41)—but does not adjust his argument according to the implications.  Paranoia and schizophrenia are serious mental illnesses that distance patients from the world in which they live.  To exploit the clinical context, to define authors and characters in fiction as schizophrenic, and then to argue that this is an entry into culture is to set oneself a very difficult task.

            Psychiatry is a rapidly-changing field which has been completely transformed by diagnostic and therapeutic practice and by drugs since Emil Kraepelin established the diagnosis dementia praecox in 1896, and Bleuler definitively replaced it with schizophrenia in 1911 with the book later translated as Dementia Praecox or the Group of Schizophrenias.  Trotter is heavily dependent upon these precursor figures, and it is not at first clear why.  He opens the book with a flourish by referring to the contemporary reference manual for psychiatrists known as DSM-IV, and this suggests he is going to use up-to-date terminology.  DSM-IV, as he explains, is the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 1994.    Trotter is writing about modernism in Britain and Europe, and we might ask why he does not refer to the World Health Organisation equivalent that is used in British hospitals and clinics, the ICD-10 Classification of Mental and Behavioural Disorders of 1992.[3]  This is the tenth edition, and it reads more sympathetically than DSM-IV.  (We should recall that earlier versions of DSM defined homosexuality as a mental illness: welcome to the authoritarian world of American psychiatry.)  The difference between DSM-IV and ICD-10, as it affects Trotter’s argument, is the guidance on differential diagnosis.  This permits a distinction to be made between Schizophrenia and Delusional Disorder, the latter being the American term for what ICD-10 calls Paranoia.  A diagnosis of Schizophrenia requires the significant presence of delusions, hallucinations, disorganized speech (as distinct from Bleuler’s preference, disorganized thinking), grossly disorganized or catatonic behaviour, and such negative symptoms as lack of affect.  These symptoms, grouped as Criterion A, are absent from Delusional Disorder or Paranoia.  In this illness, the delusions are non-bizarre, in that they could occur in real life—one might really be followed, poisoned or loved at a distance.  The key differentiation between Schizophrenia and Delusional Disorder is that in the latter Criterion A has never been met.[4] (DSM-IV, 301)  Delusions of grandeur, jealousy, persecution and illness may instead be present. 

In his first chapter Trotter writes a history of paranoia in which he insists upon the urgency of differential diagnosis.  This allows him to separate paranoia from schizophrenia and then attempt the move into culture.  Schizophrenics live in a world where every action appears contingent because they are cut off from meaning and value as a result of what Kraepelin called ‘the loss of the inner unity of the activities of intellect, emotion, and volition in themselves and among one another’ (quoted 38).  But schizophrenics copy or imitate, Trotter argues.  They imitate sounds or movements—this is known as echolalia and echopraxis—and are thus engaged in mimesis.  Mimesis is a key term for this argument, where literary modernism is said to object to mimesis and therefore be attached to paranoia.  Paranoiacs ‘cannot abide contingency’ (38) and construct highly meaningful but delusional structures where everything that happens to them can be interpreted as caused by (say) the intervention of neighbours, or the actions of a distant lover.  Here, Trotter takes Kraepelin very seriously, so much so that he makes him sound like a contemporary literary theorist: ‘To imitate for imitation’s sake, Kraepelin thought, was to abandon any notion of meaning and value, of purposefulness, of inner psychic unity’.  Against this, ‘writers from John Stuart Mill to Wyndham Lewis’ would ‘fulminate’ against mimesis, in the process ‘constituting an anti-mimetic paranoid postliberalism’. (40)  This is a very strange argument, not least because, as we have seen, one of Trotter’s main points about Lewis is that he or his texts are ‘schizophrenic’.

Setting that aside for a moment, let us turn to ICD-10.  Here we find a sub-section entitled ‘Paranoid schizophrenia’ which begins with the unequivocal statement ‘This is the commonest type of schizophrenia in most parts of the world’.  Patients suffer ‘relatively stable, often paranoid, delusions, usually accompanied by hallucinations’; these are often auditory—‘hearing voices’, in other words. (89)  The usual delusions may be present, and threatening voices may be heard, or whistling, humming or laughing.  Hallucinations of smell or taste may occur.  DSM-IV has a comparable section, a sub-type of Schizophrenia marked ‘Paranoid Type’, where the description is similar but lacks the emphasis on its being the most common type.  If we bring these features together, Trotter’s argument seems to be endangered.  Paranoid schizophrenia is a) the most common type, and b) a sub-type of schizophrenia.  Paranoia has turned up on the wrong side, as it were.  Paranoid schizophrenia mixes inescapably the two terms that Trotter must keep separate if he is to situate psychiatry within culture—so he ignores paranoid schizophrenia as a possible diagnosis of modernism.

Such rigid separation of terms ignores the widely-accepted view in psychiatric practice today, that the symptoms of mental illness occur along a continuum.  There are no sharp distinctions to be made in diagnosis, and symptoms of different kinds come and go; they may occur seriously, or as mild afflictions, or disappear altogether.  This view of mental illness is not susceptible to an either/or interpretation, and at one point Trotter acknowledges that paranoia ‘also occur[s]’ in schizophrenia, but then adds that ‘since Kraepelin’ the diagnosis of paranoia has been ‘to some degree’ (19) differential, which gets him back on the two-way street separating paranoia from schizophrenia that allows him to pursue his cultural argument about mimesis being ‘schizophrenic’ and anti-mimesis ‘paranoid’.

Just how reliable were Kraepelin and Bleuler?  Because his approach is historical, Trotter must take them both seriously: ‘They set up a durable psychopathological tradition’ he writes. (50)  He needs the 1896 term ‘dementia praecox’, and describes effects which occur earlier in life, and for different reasons, than the dementia of old age.  Trotter returns to Kraepelin’s emphasis, in the seventh edition of the German-language Psychiatrie, of ‘the “loss of inner unity” as the main cause of the disease’. (32)  This is useful because the unity/fragmentation dichotomy is already common in the study of modernism.  It is also vague, for ‘loss of inner unity’ could be a symptom as much as a cause.  Trotter stresses that dementia praecox is (or was) ‘a totalizing disorder’, distinct from paranoia.  The ‘quantitative and clinically orientated account’ offered in English as Dementia Praecox and Paraphrenia in 1919, ‘put a new landmark on the map of mental illnesses [showing] profound disturbance of thought and language’. (33)  One notices that Trotter is an extremist in diagnosis: every mental illness is a serious illness, as indeed each has to be if cumulatively they are to have an effect upon the wider culture.  Trotter disrespects the modernists—Mill and Lewis ‘fulminate’—but is oddly respectful of Bleuler, whose absurd belief that schizophrenia was the result of an unknown toxin is reported without comment.  The arguments of Paranoid Modernism are based upon an acceptance of the scientific value of the diagnoses of Kraepelin and Bleuler.

But what is the scientific value of these concepts?  Very little, according to Mary Boyle, who in Schizophrenia: a scientific delusion? (1990) argues rigorously and convincingly that the methodologies of the two researchers do not demonstrate the criteria necessary for the construct ‘schizophrenia’ to be considered scientific.[5]  (She does not deny the existence of bizarre behaviour or the suffering arising from it.)  Boyle shows that one reason Kraepelin’s Psychiatrie expanded so much between early and later editions was that he was including among the symptoms for schizophrenia the symptoms of other illnesses, notably encephalitis lethargica (an affliction movingly described in Oliver Sack’s Awakenings in 1980).  As to Bleuler, who took for granted the unproven ‘dementia praecox’ theory, ‘his work was at best misconceived and at worst futile’, Boyle writes. (60)  Of Kraepelin she writes that it is ‘surprising’ that his work ‘is given serious consideration by his successors...and is subjected to only mild criticism by modern writers’. (59)  Research in the 1980s showed that ‘the kind of “severe and long-standing cases” described by Kraepelin and Bleuler are no longer seen’, and certain symptoms they described ‘are now rare’. (65)  Boyle concludes that Kraepelin and Bleuler were investigating patient ‘populations’ to whom the term schizophrenia would today not be applied. (65)  Quantitative and clinically oriented his research may have been, but it is of little or no value for diagnosis or treatment today. 

Yet, as we have seen, Bleuler’s distinction between ‘fundamental’ and ‘accessory’ symptoms is used by Trotter to support an argument about a moment in Lewis’s The Childermass, where we recall that neologism is an accessory symptom of schizophrenia.  Boyle argues that the hundreds of behaviours Bleuler put forward as accessory symptoms lacked scientific criteria for their inclusion, and were in fact arbitrarily chosen.  Sometimes, she writes, ‘accessory symptoms were said to cause fundamental symptoms’. (62)

These criticisms ought not to affect Trotter’s historically-based argument, but here another peculiarity arises.  He concedes early on that the modernist writers did not read the writings of the psychiatrists of their own time (‘Obviously not’).  But there was an ‘endemic’ (5) problem which resolved itself in the belief that the professional classes were particularly prone to paranoia, and this leads Trotter to an argument I shall address a little later.  Struggling, perhaps, to find a definitive link between literature and madness, he concedes that not all modernists suffered from Paranoid Modernism, but makes the following revealing remark, quoted here with my emphasis:

I have on occasion sought to extend the terms of my argument by discerning ‘schizophrenia’, as that would have been understood during the early years of the twentieth century, in the behaviour represented by my chosen writers, or even in their literary methods. (12)

This seems to mean that writers could only be mad in ways defined in the psychiatric literature of the time at which they were being mad.  My reading of this book was for many chapters troubled by the possibility that its author really held this view.  On page 350 the suggestion returns:

I do not in fact believe that one ought to ascribe a condition like ‘schizophrenia’ to specific literary procedures without knowing how it was used by psychiatrists and social commentators at the time.  This it should not prove impossible to establish.  [W.R.] Bion’s thinking, for example, was as decisively shaped by the First World War as Lewis’s.

This sentence begins as though it was about to deny the astonishing assertion that it does in fact make, that mental illness can only enter a literary text in ways consistent with the definitions then current in the psychiatric literature.  It is not a primary objection to this formulation that the authors concerned had ‘obviously not’ read that literature.  The difficulty lies in the assumption that such a research project could work.  Kraepelin, caught in a time-sequence imposed by the ‘praecox’ concept, wrote of the onset, progress and outcome of the illness.  Are Lewis and the other paranoid modernists to be tracked across their entire careers under this procedure—one that was criticised from the outset, is not used today, and which Trotter does not mention, although it was put forward just as early modernism was getting under weigh?  What would count as evidence that the behaviours Bleuler said were attributes of schizophrenia, were also in some strong sense occurring in modernist texts?  The relationship would have to be strong because there is otherwise an easy answer to the question: Bleuler listed so many attributes of schizophrenia—hundreds of accessory symptoms alone—that there would be no difficulty in finding something or other that fitted a text or an author.  Given that most of these behaviours would not today count as attributes of schizophrenia, would it not then be necessary to say that any link established was provisional?  And what would be the lasting value of that?  We might consider other, slightly comical, difficulties.  Paranoia goes back only 200 years.  Macbeth was notably non-paranoid about the witches’ warnings about Birnam Wood making its way to Dunsinane.  Is that because there was no psychiatric profession in Elizabethan England?  What then of The Winter’s Tale, where Leontes’ delusions about his wife are clearly paranoid? 

Let us look at Trotter’s examples of his preferred state of madness, paranoia.  Early in the book, ‘monomania’ is endorsed.  This mid-nineteenth century term shows up later in the discussion of Tarr.  Kreisler, of course, is the paranoiac (235), but Tarr is the monomaniac (238), which comes as a surprise because Trotter does not quote the word as occurring in the novel, although we are told earlier that its legitimacy depends upon its use in nineteenth- and early twentieth-century fiction, which was apparently ‘consistent’. (18)  Monomania means—if it means anything at all—an undue focus upon a single object, and it must therefore belong to paranoia, not to schizophrenia, and this is confirmed by Trotter’s surrounding discussion of delusions of grandeur. (20-21)  It is therefore difficult to make much of this sentence about Tarr: ‘Tarr, oddly enough, given his tendency to monomania, may in fact be the first schizophrenic in English literature’.  That is inconsistent, but so is the next sentence:

In the account it gives of ‘persecution mania’ and of the need to eliminate mess from art, Tarr can be considered Modernism’s closest approximation, Women in Love apart, to paranoid narrative. (238)

Well, which is it to be, schizophrenic or paranoid?  These concepts keep popping about like a handful of Mexican jumping beans.  The answer, one increasingly feels, is neither.  This theory does not work.  Even its originator cannot control the terms he has chosen to use.

            A major theme in Paranoid Modernism is the new idea of paranoid professionalism.  The argument is that during the mid- and late-nineteenth century British society became professionalized, that specialized groups had to defend their interests, and that paranoia ‘helped’. (83)  These professions sold an ‘expertise’ which made up their cultural capital.  Clergymen, lawyers and doctors were the first professionals, and writers and artists were close behind.  Expertise was crucial to Modernism, and Lewis’s professionalism was to advocate abstraction in art.  In the early modern period, as professional identity grew, writers spent time becoming paranoid about their aspirations and careers.  But if clergymen belong to the Church of England, lawyers to the Law Society and doctors to the British Medical Association, to which professional association do a group of disorganised and often badly paid artists and writers belong?  Lewis was briefly a lecturer in Canada, and wrote for the BBC’s The Listener for a few years, but that is the entirety of his institutional attachments.  He had no university degree, and was thrown out of the Slade, so had no professional qualifications.  He believed very strongly in the profession of letters and in professionally-produced works of art.  He believed in a republic of letters, but that was precisely not an actual organisation, but the pursuit of shared values by diverse individuals across the world.  On the other hand, Lewis tended to get upset when he was not paid, or thought that work was being kept away from him, or that a powerful critic such as Arnold Bennett was never likely to review him favourably.  To define such worries as paranoid is to overstate trivialities.  But when Lewis has Snooty, in Snooty Baronet, say that he would hunt down all ‘gangs, sets, ant-armies, forces of Lilliput, number-brave coteries, militant sheep-clans—fraternities, rotaries, and crews’ (351) then Trotter argues that this sounds like Lewis’s own satirical campaigns, and that in Snooty ‘Charismatic professionalism has finally found its champion’. (352)  Snooty, of course, casually shoots Humph and in this ‘insouciance’ is found ‘the complicity of his own method with traumatizing violence and with that exultation in violence which is fascism’s signature’. (353)  So it is that the professionalization of society, which doubtfully applies to writers working alone, leads to complicity with fascism.  After all this effort, it’s the same old Lewis.

            This conclusion again suggests some fault in the argument.  Snooty is a psychopath, therefore Lewis is a fascist.  But Snooty is Lewis’s creation, and a satire on Behaviourism, which is a pernicious scientific theory perpetrated by American psychology.  Lewis objected that it reduced people to automatons, but for saying so he is found to be a fascist.  It’s not probable.  One may think of other consequences of professionalization: doctors who kill the terminally ill, archbishops who declare just wars, barristers who successfully defend guilty criminals, judges whose wrong convictions are unravelled years later.  I see a difference of scale and of impact here between real-world professionals and professionals of word and image.  Trotter is a professional of the latter kind, as am I.  Unlike him, I do not want to judge the forces of understanding and resistance by the values of capital and control. 

            Paranoid Modernism is founded on the assumption that a literary critic can make a medical diagnosis of a text or a person.  When Paul Edwards asserts that Lewis’s polemics are ‘a permanent insight into the nature of modernity’ (quoted 289), Trotter replies that those polemics are ‘mildly psychotic’. (289)  These are different kinds of  statements, and they do not match.  An intervention into culture is not answered by saying ‘You’re mad!’  Apart from my doubts as to Trotter’s interpretation of the history of mental illness, and the failure of his attempt to tie the concept of paranoid professionalism to the rest of his argument, and hence to ‘culturalize’ psychiatry, there is a distinct problem with his attitude to mental illness itself.  He sometimes seems to think it’s funny—paranoia was ‘the professional person’s madness of choice’ (7)—and at other time treats it with a melodramatic intensity intended to enforce its significance for culture.  Both attitudes falsify.  Paranoia and schizophrenia are intensely distressing medical conditions that belong, and should remain, in the world of the clinic.  The effort to demedicalise mental illness damages the interests of the mentally ill by elevating schizophrenia into something supposedly special, and (as in this book) finding paranoia everywhere and cheapening the distress it causes.  At the same time, Trotter’s diagnostic extremism prevents him from acknowledging how widespread and manageable are the mild and controllable forms of both illnesses.  Certainly, his book lies within culture, but not quite where he would wish, I suspect.  It is a contribution to the insensitive culture that attaches blame and guilt to the concept of mental illness. 

NOTES