Face aux désastres
Une conversation à quatre voix sur la folie, le care et les grandes détresses collectives

by Anne M. Lovell, Stefania Pandolfo, Veena Das, and Sandra Laugier (organized by Anne M. Lovell)

Les editions Ithaque, 2013, 204 pages.

Three anthropologists and one philosopher have joined forces and written an extraordinary book, which is a well-founded and intriguing contribution to a new ‘anthropology of madness’. Their theoretical reflections are grounded in powerful and, at the same time, sensitive insights into the lifeworlds of individuals living with psychiatric/mental illness. The four authors describe their work as a conversation about care, engaging with institutionalized, but mostly with everyday practices, and its socio-political contexts. The analytical web is so dense and multi-layered that it is difficult to summarize all the arguments in a short book review – I will only mention some of the discussions, hoping that this text will make the reader curious enough to want to know more about this important contribution to a variety of disciplines such as medical anthropology, medical sociology, philosophy, ethics, social psychology, and, of course, (transcultural) psychiatry itself.

The common thread linking the different chapters is the marriage of anthropology and philosophy – two disciplines that Lovell, in the introduction, describes as “in need of each other”. Further, the central question of all contributions is “in what kind of world, using what words, are those forms of life which we label as mad born and developed …?” (p. 8, my translation) In order to answer this complex question, the authors’ “tending to madness” consists of three case studies in which each ethnographer carefully develops her arguments by situating them in an particularly challenging context: Lovell describes mental illness during and after the traumatic catastrophe of Katrina in New Orleans; Pandolfo studies madness in a shantytown in Rabat, Morocco; Das analyses the lack of care in poor neighborhoods in Delhi, while Laugier adds an essay about the philosophy of care.

Lovell, in the introduction, grounds the four authors’ research as a contribution to a postcolonial anthropology, by analyzing new emerging subjectivities within a wider global mental health movement. She argues that subjectivities and forms of care are historically rooted, for example as in the case of traditionally racialized practices in New Orleans. Care for people with mental illness is a challenging topic, argues Lovell, because, besides the difficulty of defining madness, it is not restrained to institutions, nosologies, and medications – madness is lived in ordinary and, at the same time, messy lives, and this especially in vulnerable populations: “For certain people living an ordinary life is already an extraordinary task” (p. 15, my translation). Many people, even those diagnosed by psychiatrists, do not seek or do not get care, and this is even more so with poorer people. This is why the three ethnographers (and also Laugier in the final chapter) describe madness systematically outside of official therapeutic sites – an angle that is often ignored in anthropological studies.

Further, the four authors ground their theoretical reflections in a post-Wittgensteinean philosophy, although each in a different way. The phenomenological concept of lifeworlds illuminates the experience of people who suffer in a world that often is a world apart. Wittgentein’s concept of Lebensform (forms of life) helps to understand both; the horizontal relations or non-relations among people within a given culture, and a vertical interpretation, in which emergent forms of life become the focus. Further, a Foucauldian perspective – not necessarily one in which psychiatry is seen exclusively as State control – but one focusing on biopower, determines those practices and decisions about living and letting die.

Anne Lovell’s chapter situates the dramatic events following Katrina in New Orleans within the discussions around PTSD, pointing out that research about trauma generally does not acknowledge how trauma impacts on people who are already (biologically and socially) vulnerable before the catastrophe, such as individuals with mental health problems. Based on several examples of people receiving and giving care in a situation of “dramatic precariousness”, Lovell criticizes the Goffmanian assumption that madness means an inevitable dependency. She skilfully shows how those individuals she worked with were able to “have a voice” during the chaotic period of Katrina and were capable of giving care, without ever losing their general fragility.

Stefania Pandolfo’s chapter is about the artist Ilyas and his wife Samia, both suffering from mental illness (halas in Arab) and who are living together in a poor neighbourhood of Rabat. Their caring relationship, the “fragile love that unites them”, is grounded in an extreme sensibility towards each other and the world around them. The photos taken by Pandolfo of Ilya’s pictures – pictures painted while experiencing delirium, often destroying them once he comes out of this altered state of mind – are part of the book and can be read as an expression of an individual and his malaise towards the world, but also as a sign of cure, memory, and as a testimony of Samia and Ilya’s love story. Pandolfo draws a parallel between Ilya’s pictures and Aby Warburg’s research about the snake ritual among the Hopi in New Mexico. Warburg, a historian of art who also experienced symptoms of delirium, described the Hopi images as an “affecting effect” in which the artists could express the collective violence they experienced.

The third chapter, written by Veena Das, analyses madness in the context of the very poor living in a modern India. She describes her objective – somehow surprisingly – by referring to Max Weber, as “exploring ethnographically how, within the context of urban poverty in India, one can conceive modernity as enchantment” (p. 136, my translation). Das convincingly criticizes psychoanalytical theories based on a theory of broken narratives in mental illnesses. Following Swapan, a 20-year old man living with his parents and brother in a poor neighborhood in Delhi, Das shows in detail the multiple reference systems in which Swapan’s narratives make sense. Making reference to Canguilhem who speaks about the creativity of pathologies, she distinguishes between the pathologically normal and the normatively normal: “I have seen too much suffering and violence to say that mental illness is just a social construction or that its symptoms are forms of resistance. (…) Swapan’s story is less about a ‘loss of self’ or a ‘narrative discontinuity’, but the discovery of the multiples exclusions he is living” (p. 158-159, my translation).

Sandra Laugier, in the last chapter, provides a profound reflection on the ordinary life in which care takes place. Relating especially to Veena Das’ ethnography and her Wittgensteinean framework, Laugier shows us the complex and subtle relations at work in ‘care’ – and the importance of being aware, of seeing the detail and particularities in order to care for each other. She concludes by making reference to Cavell’s Les voix de la raison, that mental illness is not just the breaking of rules, of living against norms and rules; people with mental health problems often need to find a language that in many cases is the language of the other. The so-called normal people rarely learn or get close to the language of the mad. By refusing to listen we become incapable of recognizing these individuals as human beings and, as a result, we can let them die, unable to care.

I recommend this book to everybody interested in a deeper reflection on madness – “the tragedy of the ordinary” (p. 25), as Lovell writes. Maybe, with the exception of undergraduates who will have some difficulty with the many references made to previous (philosophical and social sciences) discussions around life and the life sciences, this book will become an incontournable for scholars from a variety of disciplines. This is a unique and challenging analysis that makes us think and, at the same time, it forces us to recognize the other who, finally is not so different from ourselves, if we listen well.

Annette Leibing is a medical anthropologist with a special interest in psychiatry, ageing (esp. Alzheimer, Parkinson), medications, and, more recently, the cultures of stem cells.  She is professor of medical anthropology at the Faculty of Nursing, Université de Montréal and a researcher of the research groups CREGÉS (Qc), MéOS (Qc) and PACTE (France). Her most recent books are entitled Thinking about Dementia: Culture, Loss, and the Anthropology of Senility (Rutgers University Press, 2006; co-edited with Lawrence Cohen), The Shadow Side of Fieldwork: Exploring the Blurred Borders between Ethnography and Life (Blackwell, 2007, co-edited with A.McLean), and a volume on “technologies of hope” (PUL; in French; co-editor Virginie Tournay).