This is the transcript of a a talk that I gave at the University of Durham last June….it is a piece of ‘academia’ – with all that entails – but it is nevertheless written from the heart (and indeed, after my heart and my confidence in it, I must confess, had taken a knock or two!)

The Abject Artist:
exploring the multidimensional capacity of art to express and communicate the experience of illness

I am a visual artist. My fundamental passion is for exploring the human condition and the way we engage with what we perceive as our world, and, because passion is closer to the surface perhaps in the realm of suffering, I work primarily both within and around the world of medicine. I work directly with patients and with health professionals using language, through conversation and unstructured interviews, and imagery, through sketches and photographs, to inform further work executed in the studio. I therefore use art practice as an explorative process towards expressing and communicating the experience of illness and its overall impact on a patient’s life. I make visual ‘portraits’ of the relation between objective and subjective understanding and experiencing of varying degrees of dis-ease. I try to communicate passion through art in order to promote further understanding and awareness, in the world of the healthy, of what it might feel like to be residing in the world of the sick.

My academic background is in philosophy and the philosophical rationale behind my work is usually tacit in the talks that I have given about the art projects I am developing. But today I would like to bring it to the fore and talk about my methodological approach, especially as I have come to the understanding through my work that philosophy, when considered itself as a practice, is inextricable from the creative practice that is my driving force overall, and especially too because I have given up trying to squeeze my flights of fancy into boxes that purport to assert rigour yet lack the capacity to contain risk. Moreover, where my practice is firmly rooted in the Deleuzean aesthetic I reject the linearity of the taproot and embrace the diverse potential of the rhizome, whose botanical counterpart can be found in the pervasive couch grass.

As a creeping underground stem, couch grass is most often seen by those in the horticultural field as a problem, something to be at best tolerated, at worst eradicated, and similarly perhaps, in the relation between art and medicine, the value of the aesthetic has become, over time, a complex issue wherein the aesthetic is often accommodated as a fortunate, but merely decorative aspect of fantastically accurate technology and digital representation. Sadly, understanding and appreciation of the potentiality of a productive – rhizomic – art-science relation have been steadily eroded at least since the Royal Academy in its wisdom precipitated the rise of natural philosophy over natural history in the in the late 1700’s. I don’t want to stray too far along art history’s tangent here but we might say that artists of that time, in following the perhaps overblown views of Joshua Reynolds, did themselves no favours.

In the aftermath of their disdain for the work of such artists as Jan Van Rymsdyk who made the beautiful and in my opinion emotionally charged drawings for William Hunter’s Anatomy of the Human Gravid Uterus, and in the sometimes harsh light of technological advancement, the contemporary significance of conventional art practice in medicine, now deprived of its historically pivotal role in medical illustration, is slight.

Even so, as an artist living here and now, in health and in the 21st century, I believe that where history and philosophy play their own crucial parts within the tension between artistic and scientific thought and practice, and most importantly between objective understandings of disease and subjective experiences of illness, creativity, the art process itself, has the potential to not only reinstate its crucial and functional relation with medical advancement, but also become an advocate for the reinstatement of the patient, whose distinctiveness as a human being is too often lost within the mechanism of the ‘treatment regime’. I understand the majority of my own work as a fundamental ‘act of empathic witness’ and it is within this concept of creativity that the subjectivity of the individual is prime, and is valued and nutured. Art can in this way shake of the limitations – some might say the shackles – of mere depiction and express that which is far beyond representation in the conventional sense.

Creative ‘acts of witness’ then are directed towards a more complex relation between art and medicine than that defined by medical illustration as we would generally acknowledge it. In philosophical terms, drawing on the Deleuzean rhizome, artworks that I create become what I would call tangential expressions that derive from specific nodal moments of existential experience within the hinterland of a world that is divided by Susan Sontag’s bi-polar Kingdoms of the Sick and of the Well. In the hinterland the couch grass can flourish undisturbed.

I am not saying of course that art could or indeed should ever replace science, only that it can help to humanise the scientific perspective and, in doing so, serve to instantiate the ‘person behind the diagnosis’, the individual whose illness often goes unheeded in the necessity to treat the disease. An evocative example here is that of a woman I recently worked with who had been diagnosed with endometrial cancer and was undergoing the prescribed treatment, which included surgery and radiotherapy. As she talked very eloquently of her feelings of being alone in a place she called ‘no-man’s land’, the profound significance of this was not lost on me. Along with many other allusions to her emotional and physical experience of the overall illness, the ‘no-man’s land’ metaphor signified for her the borderless and empty expanse between the two Kingdoms of the Sick and of the Well, wherein she felt trapped. No-mans land of course is a term associated with trench warfare and, as we all know, allusions to battles with losers and survivors are rife in relation to cancer. I have found that these allusions however, aren’t used so very much by cancer patients but more by their carers. I didn’t get the impression from this particular lady that she felt in any way either warrior or a victim. It wasn’t a battle she was fighting, just a sense of loss of identity, of loneliness in a crowd.

I digress! But positively, for it is only where digression gives way to regression that we have a problem.

It is through practice then that I am attempting to reinstate the credibility and value of art in relation to medicine, and use it to express and communicate the nuanced, and sometimes life shattering experience of illness. I am doing so not through any effort to reprise the historical role of art – this is indeed unnecessary and it has in any case long since been superseded – I am rather by exploiting the potential of imagery created by the human hand, imbued as it is with unadulterated subjectivity, to raise awareness and understanding of the existential ‘lived’ experience of life without full health. As methodology, intuitive creativity therefore takes on, its own right, a crucial role both in the particular and in the general sense with respect to a research process that is situated – if indeed it needs a location – within the remit of the Critical Medical Humanities. The theoretical framework that supports my methodology overall is generative of what I call my ‘autoethnographic stance’. It forms the basis of a profoundly self-critical analysis of praxis.

Since first exploring the methodological merit of autoethnography as part of my PhD, I have been developing my own approach to research through creative practice based on its fundamental concepts, and for me, the autoethnographic stance is not just the most productive basis from which to work, it is also the most credible. Where medicine posits a distanced observer who observes the cultural other and postulates objective truths, autoethnography breaks any barriers between observer and observed, self and other, by conflating all into one person, in this case, myself. As an artist I respond to experience, as a researcher I use tenets of autobiography and ethnography to engender this response. Autoethnographic account and/or expression draws upon and explores experience with a focus more on personal subjective responses than on the beliefs or practices of others and for some this may seem, on the surface, a worrying example of self-indulgence. Such a concept, from an artist’s point of view, is not so reprehensible since creativity and abject subjectivity go hand in hand and art would itself suffer if this were not the case. However, and to satisfy the advocates of rigour, any surfeit of subjectivity and/or descent into solipsism is prevented in this case by the application of a judicious and theoretically rigorous framework that locates me, as subject, within the cultural milieu. The focus therefore is not solely on myself as artist but on my experiences within different medical settings and it is in this acknowledgement of the complex connection between the individual and the cultural that autoethnography is able to accommodate and legitimise the personal context.

The projects I am currently working on are Drawing Women’s Cancer, which is an exploration of women’s experiences in dealing with the impact of gynaecological disease,

Drawing Out Obstetric Fistula, which explores the devastating consequences of maternal birth trauma, working with women in Tanzania, and

Medicine Unmasked, which explores the learning and teaching experience of medical students and faculty during an ‘oncology apprenticeship’. The projects are discrete in their own right but profoundly interconnected, and given my emphasis here is on the philosophical, the crucial point here is that the distinct nature of each, valid as it may be, is ultimately less important than the fundamental relation between them; the overriding and sometimes overwhelming process of creative production, which can be summed up as a form of communication through practice that engenders a profound interrelation of reflection (after the fact) and self-reflexion in the thick of the action. As an artist, such interrelation has always been a part of how I work but it has become increasingly significant as my work in medicine has gained momentum, and, because everything that I do turns on the profound critical analysis of my own role as ‘the artist’, it is obviously very important to consider what that role actually is, and what it means in terms of the outcome. I have discovered, and I use that word deliberately, that it is the concept of the abject, in tandem with the autoethnographic approach that gives the work I do its credibility as research, and hopefully value in terms of changing perceptions.

So, The Abject Artist, is the working title for the overall concept that brings together all of the projects I am developing. Kristeva notes that the abject indicates ‘that which disturbs identity, system, order, and disrespects borders, positions, rules’ and abjection itself occurs at the point where a sense of normal identity becomes indistinct, where accepted meanings become disembodied through loss of distinction between self/other, subject/object, and the narratives we live by break down and become fragmented. For me, this is paradigmatic of both the illness experience, ‘where sense topples over into the senses…[and] Being [becomes] ill-being’, and the creative process. They both embrace in their respective ways that which is in-between, ambiguous and composite, and it is within this fragmentation and ambiguity that my focus on the role of art practice in medicine is defined.

Through immersing myself in individual stories of illness and creating visual imagery from my subjective response to the sense of abjection that these stories often entail, I become myself, in Kristeva’s terms ‘one by whom the abject exists…a ‘deject’ who places, separates and situates herself and strays instead of getting her bearings. I can identify with the idea that the ‘deject’ asks “where am I?” rather than “who am I?” because the space in which I exist as an artist is, as Kristeva describes, essentially divisable, foldable and catastrophic. Indeed the ‘catastrophe’ is Deleuze’s climactic idea of the artist’s final challenge as emotively explicated in his book on Francis Bacon, The Logic of Sensation, and although I argue against him in my own book, Narrating the Catastrophe, I have to agree with the basic idea of a creative process that is essentially irrational, yet full of positive and unending potentia

Narrative, as I hear it during what I call individual ‘encounters’, and as I observe it while on the sidelines of the illness experience – is an important part of the work that I do, but narrative in the conventional sense is too restricted and culturally limited a concept to serve my overall purpose. As such I prefer to think of dialogue as being the key to my process; dialogue between myself and the subject, between myself and the responsive drawing as I create it, and between the viewer and the finished works at the public art exhibitions that serve, on a different stratum, as research ‘outputs’. Moreover, it is the dialogue that the artwork generates outside and beyond itself that is really important. This is what I call a ‘meta-dialogue’ generated in the creative transgression of objectivity. The meta-dialogue is a ‘fractured’ narrative that, drawing on abjection, becomes a form of communication that further transgresses verbal, written and even visual language, and within which the fundamental aim is to engender a viewer’s response to the subjectivity that is inevitably inherent in the artwork in the hope that this will enhance his or her awareness and understanding of the existential experience of the ‘Other’. In this way the meta-dialogue demonstrates its capacity to speak the unspeakable, to articulate suffering across social and cultural boundaries, taboo and stigma, and where the ethical role of narrative focuses on stories of personal experience that form a basis for moral reflection, the meta-dialogue holds within itself the power to influence both practice and policy.

To conclude, it is hopefully clear by now that the creative act, for me, goes beyond mere documentation or representation and even beyond itself in terms of the dialogical relations that it both entails and engenders. In the medical setting, as an act of empathic witness, and in accordance with Arendt’s distinction between pity and compassion, creativity demonstrates the latter through its nature as a practical response. Maybe it is compassion then that drives the work I do, but in any case this is less important than the fact that art becomes both agent and advocate of patient autonomy through its unique capacity to engage viewers’ subjective sensibilities. I understand my role in this process as going beyond Radley’s concept of ‘asymmetric relation’ between artist and ill person; it is more a complete immersion of my subjectivity into the world of ‘Others’, wherein boundaries are blurred between objective rationalism and the passionate human need to co-exist and share experience. I have no regrets over sidelining the safety of transparent rigour in my work because my focus is more on raw emotion than on refined intellect and as an artist I must take risks. I offer then no claims to objective truths, only profound insight into subjective experience that reveals its own truth whilst keeping open the avenues of exploration.

Artists are like philosophers. What little health they possess is often too fragile, not because of their illnesses or neuroses but because they have seen something in life that is too much for anyone, too much for themselves, and that has put on them the quiet mark of death.

(Deleuze and Guattari 1994:172)