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The art of psychiatric patients has been presented often in different sites and it has become a part of the regular collections in museums worldwide as well as a part of the art-market in galleries and auctions

"Psyche and Art"

Art Exhibition of the XIth World Congress of Psychiatry

The art of psychiatric patients has been presented often in different sites. It has become a part of the regular collections in museums worldwide as well as a part of the art-market in galleries and auctions. Nevertheless exchange of scientific research about the fundamentals of creativity is still scarce. The Hamburg exhibition is an attempt to focus on the basics of creativity to start an international and interdisciplinary dialogue on the relationship of Psyche and Art.

In the following I will present the concept of the Hamburg exhibition with reference to some of the images, and will propose a theoretical approach which has developed as a result of this exhibition. Hopefully this step towards a further understanding of the fundamentals of art and creativity will entice others to join us in further research.

In 1922, the German psychiatrist and art-historian Hans Prinzhorn published his "Bildnerei der Geisteskranken (Art of the Insane)". In the pictures of his psychiatric patients Prinzhorn intended to find a pure art without any environmental influence, hence revealing an inborn human drive for art creation. Philosophically this idea can be traced back to the romantic tradition which had already influenced the expressionists at the turn of the century or later the surrealists and the movement of Art Brut.

Even Navratil took a similar humanistic creatologic point of view. A new world of art was discovered, which aroused a deep fascination. The concept was misused by the Nazis for legitimization to condemn modern art itself as sick, and to murder thousands of its producers, patients as well as artists. As a consequence of this historic catastrophe the questions Prinzhorn had asked, so far have not been further addressed, although research in psychiatry, neurobiology and philosophy has expanded significantly.

For decades a narrow definition of how art was defined by art-historians helped to exclude psychiatric or psychodynamic theories from art-analysis because of the fear of refueling a potential condemnation of modern and contemporary artists. Just recently the concept of an expanded art-history ("erweiterte Kunstgeschichte") was introduced.

At this point we surely cannot expect full understanding of the complex relation between psyche and art. Nevertheless, apart from the fascination of the topic, it seems worthwhile to take a new look at this field on the basis of our current scientific understanding.

Therefore, the main goal of the exhibition is to ask questions. It is not only to present pictures of patients like several exhibitions have done (although in an excellent manner such as the recent "Kunst und Wahn [Art and Delusion]" in Vienna), but rather to use these images as a baseline for an interdisciplinary dialogue about the mechanisms which define the human psyche.

As Goodman put it "The field of psychiatry represents the intersection and potential synthesis of perspectives offered by physiology, psychology and philosophy." Others have put forward similar concepts, and it is here, where the importance of psychiatric knowledge for the understanding of art and of the creative process becomes obvious.

To achieve our goal of understanding, the following "Chain of Questions" leads one through the exhibition, each question represented by a section of pictures.

 

1. Who defines what is called art and how is it perceived?

The concepts of what is defined as art underwent dramatic change during the 20th century (paralleling the changes in society). As art had been linked to religion in European societies until the revolutionary changes during the Italian Renaissance, our century broadened the concept of art to the extent that Joseph Beuys declared "Jeder Mensch ist ein Künstler." ("Everybody is an artist.")

This liberation of art for the first time allowed reference to the paintings of psychiatric patients also as art, a step Prinzhorn still had been reluctant to undertake, when he spoke of "Bildnerei (picture-creating)" instead of "Kunst (art)". The expansion of the concept of art now also allows methods of analyzing it to be developed further. The images from patients as well as those from artists can become a focus for analysis from a psychiatric, psychological or psychoanalytical perspective.

Anxiety can be considered a key-symptom of psychiatric illnesses. Could it be that the anxiety-experiences in the 20th century’s societies paved the way for the acceptance of the art created by our patients? Can the common neglect and even avoidance of this art by a major part of the population be understood as a result of a defense-mechanism against these anxiety experiences by simply declaring the art itself as sick? An extreme example is the killing of patients by the Nazis and their banning of modern art by its comparison with psychiatric art.

Can art itself be sick? My answer to this is clearly: "No!" It must be emphasized that we need to separate the judgement of the quality of a piece of art from the possible health or illness of its producer.

As Prinzhorn wrote "Der Schluß: dieser Maler malt wie jener Geisteskranke, also ist er geisteskrank, ist keineswegs beweisender und geistvoller als der andere: Pechstein, Heckel u.a. machen Holzfiguren wie Kamerunneger, also sind sie Kamerunneger." ("To conclude that an artist who paints in the fashion of a mentally ill patient therefore also must be ill, is no more logical than to conclude that Pechstein, Heckel and others who create statues in the fashion of the Negroes from Cameroon, hence they are Negroes from Cameroon.")

Another topic has to be addressed. What are the consequences of the reception of their art for the patients? What happens to the painting patient, when suddenly his pictures are valuable? Does this help him to integrate into society or does he face the idealization of his art and thus the urge to stay in the state of suffering from his illness to allow a prolongation of this specific creative process? The artist A. Rainer opposed what he considered the destruction of the psychotic creativity by pharmacotherapeutic treatment.

Gugging was one of the first places in the world for psychiatric patients to be accepted as "real" artists. Therefore pictures by some of the most renowned Gugging artists from the early days being part of the collection of the "Museum für Moderne Kunst" in Vienna are shown in the first section of the exhibition, such as Hauser and Walla, as well as those from the current generation to have an idea of the historic development of the perception of the art from Gugging.

 

2. How does art develop?

Psychophysiological aspects of the creation of art, though still scarce, are addressed in this section as well as the current knowledge about biological mechanisms of perception. The role of effects in the creation and perception of art is discussed mainly on the grounds of psychoanalytical theories. The aesthetical (society-dependant) versus the affective (empathic) aspects of perception in general might be to some extent concluded out of this theoretical analysis.

Extreme examples of patients´ art may provide a gateway to the discussion of this question. They also lead to the question of what is interesting and fascinating in the art of psychiatric patients? This section continues of the first, by presenting pictures from the academic artist Peter Pongratz, although never ill himself, was through his fascination, influenced by the Gugging artists with whom he closely worked together in the 1960s.

 

3. Does the psyche influence art?

This assumption was often concluded by psychiatrists, at the same time it was vehemently rejected by art-historians. This was especially true in Germany where the discussion was pursued by the nazis to legitimize their persecution of artists as well as psychiatric patients. So far there have been few attempts to solve this problem, but my own research in this field provides some examples of the close links between the psyche and its creations, one of them being art itself.

Does this influence affect the content or the style of a picture, or even both? Are there specific changes in the creative process in some specific psychiatric illnesses? This is likely, as specific behavioral changes occur which sometimes even define the illness. How can an understanding of the creative process in the extreme as it can be found in psychiatric conditions help to understand creativity in general? The pictures in this section show the development and variation in style of two artists under the influence of their psychological condition, making it likely, that indeed there is a close link between the state of the psyche and the creative process.

 

4. Does the art of psychiatric patients reflect a creative process without influences from the surrounding?

Prinzhorn took this assumption for granted without ever proving it. Many artists also perceived the art of psychiatric patients, led by romantic traditions in order to find the pure human art, the inner human soul without its deviation by cultural influences. An intercultural comparison of psychiatric art from all over the world is an approach to address this question.

There seem to be parallels in the patients´ pictures crossing the borders of all cultures, but there are also culturally specific influences defining the human being inevitably as a member of the culture in which he or she was raised. This section dominates the exhibition as it provides the opportunity to show a whole range of psychiatric art from ten countries of Europe, North and South America, and Asia.

 

5. The psychodynamic function of art / the psychodynamics of creativity

Psychoanalysis so far, still seems to be the only science of the psyche-spectrum that developed detailed theories about the creative process in terms of its psychodynamic function since the first reflections upon this subject by S.Freud. The historic development of the different psychoanalytical approaches is presented, as well as the current knowledge and diverse theories in this field. But what is a theory without some practical examples? Therefore an attempt is made to provide some specific examples reflecting these theoretical implications by showing a psychoanalytically understandable development during a process of art creation by an artist / patient.

 

6. Art-therapy

Art-therapists have been using the creative potential of patients to support further development for a considerable amount of time. There are two different approaches, one based on the assumptions of psychoanalysis, and the other to use art production as a method of training the brain - mainly the right hemisphere - and enhancing the self-esteem of the patient. The development of a therapeutic process allows further understanding of the links between art and states of the psyche.

As mentioned at the beginning these questions try to approach the fundamental problem of art as a function of the psyche. In detail some renowned scientists have worked out their theoretical approach in the catalogue of the exhibition (Thomashoff/ Naber: Psyche und Kunst, Schattauer-Verlag, Stuttgart 1999).

 

 

I want to continue by presenting some theoretical approaches which can be learned by pictures of the exhibition and by considering modern developments in research:

At the beginning of the 20th century the concept of art was significantly expanded. Picasso created the first "modern" picture in 1907 (Les Demoiselles d´Avignion) and the reception of art in society followed the path of this expansion. At the same time first steps were made to detect the new territory of the psyche.

Developments in both areas have been revolutionary. A connection between a current understanding of the functioning of the psyche and the creative process can be very fruitful in learning more about creativity and therefore also how creativity might be helpful in therapeutic processes.

Otto Kernberg has developed a model of the psychic structure by linking the psychoanalytic theories of drives (S.Freud at al.) and object-relations (M.Klein et al.), which can provide a helpful approach for understanding the processes involved in the creation of art. His concept basically concludes the following: The human brain consists of a genetically and biologically determined structure which throughout life is modified by experience because of its emotional importance, especially by those of personal relationships. Through this process a model of internalized relations evolves in the form of psychic structures determining all further experiences in life. All perception is filtered through former perceptions or as constructivists would put it, all perception is created by former perceptions. In essence, this concept is a baseline for the existence of subconsciousness. This has tremendous implications for the understanding of art. Each creative process and therefore each piece of art is a result of a reconstruction of former experience.

At the same time biological fundamentals of all brains of human beings are largely similar. This is also on a smaller scale true for animals and why we are able to communicate with them. A product from a brain of one person principally can be understood by another. The more the brains are similar, the better the communication. If for example the cultural background of two individuals is similar, the parallels of their brains are larger than just the biologically determined fundamentals and the areas of common understanding are larger.

If one considers that each piece of art is a means of communication, every communication is (mostly consciously) directed towards a real or fantasized other being, and (mostly unconsciously) towards oneself in the form of internalized images of the self and of others. Art can be the source to identify those internalized images, that are projected onto the real other. This is equal to the transference, that is projected onto the more or less blank screen of the analyst in psychoanalysis. The psychic structure of the artist is the base of the creative process and includes and reconstructs influences from the outer world.

The fundamentals of this process are the same in artists and non-artists with the distinction between both groups made by the recipients. Because of the extremes in which psychiatric patients often live, the art they produce may allow identifiable influences from the psychological condition onto the piece of art. This assumption can be proven by looking at some of the pictures from schizophrenic patients of the exhibition.

In psychosis, normal thinking is deconstructed and similarly the internalized images as part of the thinking structures are as well deorganized. It is obvious that this process leads to an existential fear, which itself enhances the process of deorganization. Parallel to the agitation of acutely psychotic patients, the drawing style during such an episode is chaotic and characterized by dissolving structures, as can be seen in the picture "Suggestions to Altruism" by Anton Blitzstein, who in a text retrospectively described the massive fear, he was in, while drawing it.

If a patient succeeds in developing a subjective explanation for the fear he is in, the level of fear is reduced. This is exactly the cause for the development of a paranoid system, which therefore I do not consider as the illness itself, but as a defense mechanism against it! In the same way that repression is the key defense in neurosis and splitting is the key defense in borderline conditions, paranoia may be the defense against psychosis.

The second picture of Blitzstein "Fullmoonnight" shows a stabilized drawing style. He describes that this picture shows the moon-calves, visiting him regularly. He never has a camera with him, which is why he can only draw them. This paranoid thinking allowed him to stabilize, which can be seen in its style.

If the schizophrenic process continues and the defense through paranoia is no longer sufficient, the deorganization of thinking continues. This results in parallel monotonous thinking and monotonous structures as a drawing style. Examples of this are the pictures of Franz Kamlander, who paints nothing but cows or the picture of Claudio Uliveri, painting only abstract pyramid structures.

In addition to these examples of a connection between thinking processes and art creation, there are certainly many more new findings awaiting us in this field. For example in my research on the psychodynamics of the German expressionist painter Ernst Ludwig Kirchner, suffering from a narcissistic personality disorder, I found many signs for a connection between the state of his psyche and the style as well as the content of his art.

1. Prinzhorn, H. (Berlin 1922) Bildnerei der Geisteskranken

2. Navratil, L. (Linz 1965) Schizophrenie und Kunst

3. Navratil, L. (München 1969) Psychopathologie und Kunst

4. Röske, in: Brugger, I., Gorsen, P., Schröder, K.-A. (Wien, Köln 1997) Kunst und Wahn, p. 264

5. Brugger, I., Gorsen, P., Schröder, K.-A. (Wien, Köln 1997) Kunst und Wahn

6. Goodman, A. (1991) Organic Unity Theory: The Mind-Body Problem Revisited. The American Journal of Psychiatry 148:5, May 1991, p. 553

7. Warnke, M. Gegenstandsbereiche der Kunstgeschichte in: Belting, H. et al. (Berlin 1985) Kunstgeschichte, p. 33

8. Beuys, J.in: Bastian, H. (Berlin 1988) Joseph Beuys - Skulpturen und Objekte, p. 11

9. Prinzhorn, H. (Berlin 1922) Bildnerei der Geisteskranken

10. Prinzhorn,H. in Brugger, I., Gorsen, P., Schröder, K.-A. (Wien, Köln 1997) Kunst und Wahn, p. 12

11. in Brugger, I., Gorsen, P., Schröder, K.-A. (Wien, Köln 1997) Kunst und Wahn, p. 412

12. Thomashoff, H.-O. (Diss. Hamburg 1993) Der Einfluß der Psyche auf die Selbstportraits Richard Gerstls

13. Thomashoff, H-O. (Diss. Hamburg 1997) Die Suizidalität in Leben und Werk Ernst Ludwig Kirchners

14. Gorsen, P. in: Brugger, I., Gorsen, P., Schröder, K.-A. (Wien, Köln 1997) Kunst und Wahn, pp. 92-94

15. Freud, S. (Wien 1912) Eine Kindheitserinnerung des Leonardo da Vinci

16. Pöldinger, W. (1985) Die Bedeutung der Kreativität für die Rehabilitation, Schweizerische Ärztezeitung / Bulletin des médecins suisses, Band 66, 1985, Heft 10, pp. 409-411

17. Kernberg,O.: Borderline Conditions and pathological Narcissism, New York 1975

 

 


 

Speaking on behalf of the Psychopathology of Expression section of the World Psychiatric Association, we wish to continue expand the exchange of scientific knowledge in the field of creativity. We encourage the reader to join with us for further scientific discussion or for possible further exhibition projects. Anyone willing to participate in this research project, please contact me.

Dr.phil. Dr.med. Hans-Otto Thomashoff, Chairman

Section of the "Psychopathology of Expression" of the WPA

Kumpfgasse 3/8

A-1010 Wien

AUSTRIA

Tel./ Fax: 0043-1-5139437

e-mail: thomashoff@utanet.at

 

 

 


 

 

 

THE HISTORY OF PSYCHIATRY´S RELATIONSHIP WITH CREATIVITY

By Vittorino Andreoli

Examining the recent history of the study of the relationship between creativity and insanity, with special regard to pictorial expression, two events stand out as markers of the beginning of a new Vision and new enthusiasm for this area. The first event was the initial World Congress of Psychiatry in 1950 in Paris, which included a major exhibition of graphical works by the mentally ill from around the world. It was the first time so many works had been shown together, giving a sweeping view of the output of individual art studios in mental hospitals around the world.

The World Congress was chaired by Jean Delay, a leading figure in psychiatry, one whose name is linked with pharmacology for his role in the clinical characterisation of chlorpromazine, the first major tranquilliser or antipsychotic drug (the name given these agents, beginning with chlorpromazine). His achievements, important in themselves, obscure another of Jean Delay's major contributions, the desire to organise a major exhibition of graphical work by the mentally ill at the Paris Congress. He delegated this task to a colleague, Robert Volmat. nevertheless, it was Jean Delay, who was the driving force behind the event. The cultural work of this psychiatrist is less well known. Among other things, he authored a magnificent biography of André Gide, in which the personality and psychology of a work's creator are examined as an integral part of the analysis.

Jean Delay had a special intuition about the dynamics of his patients, even though he knew many of them only indirectly, affected as he was by a near-phobia of contact with them. Many remember the discussions of cases and his great ability to identify dynamics that others missed, enabling his students to verify the symptoms directly.

Robert Volmat, the art exhibit organizer, was then a young assistant. He, too, was a man of culture. He was a part of a European tradition of psychiatry based on the humane sciences and not yet focused on the mechanics of the body. These individuals were part of a group of humanist psychiatrists whose absence is acutely felt today.

Volmat devoted himself to bringing the works together, and the resulting exhibition served as the theme for his book L‘Art Psychopathologique, published in 1956. The initial World Congress exhibition was the starting point for an analysis of styles and the relationship between the graphical product and pathology. Evaluation was done in the analysis of the use of colours, while another study examined the techniques and instruments used in representation. A new, empirical vision of the relationship between graphical activity and insanity emerged.

A second key date was 1959. This time it was not in Paris but in Verona, a small city in northern Italy already known to psychology as the birthplace of Cesare Lombroso. In honor of Lombroso, each year a study day was organised on the occasion of his birthday and in 1959 it was celebrated with a major exhibition of psychopathological art organised around the works produced in a unique environment: the atelier of the San Giacomo della Tomba mental hospital. This style and type of output had attracted attention throughout Europe, and was the starting place for painters of international fame both in the world of psychiatry and art world in general producing names such as Carlo Zinelli.

The Lambroso celebration saw the establishment of the Société Internationale de Psychopathologie de l´Expression (SIPE). There was now an established organisation devoted to fostering interest in this form of communication by the mentally ill, charged with the duty of organising international conferences. The goal of the group was to transform what had hitherto been a collection of unsystematic observations into a proper scientific discipline that examines graphical activity both as a sort of ergotherapy and as a form of non-verbal expression. This is especially important in cases where normal communication is difficult (schizophrenia, for example). Another interest of the organization was tracing a language closely tied to the unconscious, a possibility indicated by the observations of other psychiatrists, notably Jung, thus bringing the study into the clinical realm. The society (SIPE) has grown in the number of psychiatrists involved in the field, kept to its mission and over the years, has promoted meetings and expanded the range of its interests. Thus, the 1950 exhibition surveyed the graphical activity of the mentally ill, while the 1959 exhibition witnessed the establishment of a society devoted to the study of such work because of its clinical significance, both as an occupation and as a way of liberating content that would otherwise go unexpressed.

Visual signs could become dear expressions of symptoms, but obviously, there is always the possibility that the patient would produce a work of artistic significance. The latter aspect has always been somewhat ambiguous, because although one could be struck by the beauty of some of the products of madness, there was nevertheless a feeling that the psychiatrist should not invade the world of the art critic, never mind formulate aesthetic judgements. lt was for this very reason that the “art psychopathologique" of 1950 become the ”psychopathologie de i'expression" of 1959.

We have now arrived at 1999 in Hamburg with half a century of history and an occasion not so much to celebrate what has been accomplished, but rather to ask ourselves if it is possible to compare the output of the mentally ill today with other works produced over this span. Any attempt to make such a comparison raises the problem of whether the graphical activity of the mentally ill taps a collective unconscious linked to a historical dimension, or if it is influenced by the culture of a society. A culture that at the level of the individual patient could well have been modified by mental alterations or by the socially-closed environment of the mental hospital.

A remarkable number of conferences and symposia have been organised over these fifty years by SIPE, which has gradually added national sections developing a network of interests and activities. The history of these conferences charts the developments of these past fifty years and it would be a valuable exercise to analyse the results that the various conferences have produced in this field. In short, we should treat the annals of non-verbal communication with the same tools that historians have used in examining the congresses of the Communist International. Obviously, such a task lies outside the scope of this presentation. Here discussion is limited to a number of fundamental strands of work that provide a summary view of the development of this field.

One such strand involved the aim of developing a “graphical chart", which would enable us to associate the different expressions of psychiatric pathology with certain “graphical signs". Special attention was paid to schizophrenia, but efforts were also made to identify correlations with other forms of pathology, from depressive syndromes to manic states and oligophrenia. A second strand involved the use of graphical activity as therapy. The idea was that graphical expression could be used as a way of elaborating conflicts, or even of gaining awareness, and thus hastening the healing process. In fact, many cases have been recorded of patients improving during graphical activity, with violent behaviour going into remission. Such work appears to exert a sedative effect thanks to its power to restrain anxiety and provide a new channel for exchange with the external world. However, there have also been cases where little or no therapeutic effect was observed, or where the situation has even deteriorated. The hope that pencils and watercolours could be used reliably as therapeutic instruments has thus been dashed.

The third strand of research has been examining the graphical activity of the mentally ill within the themes of the unconscious, for which the most methodologically-structured form of interpretation is psychoanalysis. Psychoanalysts had initially used graphical expression to describe dreams, as a more direct and complete means of reproducing their contents. Elements that verbal recounting might miss could be recovered through images. Non-verbal expression subsequently became a form of relationship on its own, an instrument of transference. Underlying this vision were studies in infant psychology and the efforts to apply a Freudian approach to mental disturbances in the very young. Especially in autistic children, where communication may even be non-existent. As Anna Freud herself argued - drawing, gestures, mimicry, become the only way to penetrate the unconscious and establish transference.

Attention then passed from the world of children to that of adults, with the hope that graphical works could be used in the analysis of the ego. This was especially the case with psychotic patients, who could be considered heterodox subjects in the Freudian theory that they would be incapable of transference owing to the loss of the unity of the ego (which is still quite present in the neurotic subject). We therefore have many examples of non-verbal communication being used in psychoanalytical work.

This strand was of great importance because it attempted to look at graphical activity as a language, with its own semantics, syntax and grammar (the art studios were even called ”graphical language laboratories"), with specific characteristics that distinguishes this work from art. The analysis of this language within a psychoanalytical interpretation gave special weight to the graphical symbol, viewing it as a hidden form of communication to be decoded. Accordingly, the graphical analogues of metaphor and metanomy in verbal language were sought. Paintings were seen as a sort of “Rosetta Stone", where the discovery of a symbol could be the key to interpreting a relational difficulty, a symptom or a pathology. Naturally, the way this approach was used varied according to the school of psychoanalysis involved. The most enthusiastic were the Jungians, but less so, the orthodox Freudians. The various schools showing considerable interest in this approach took their inspiration from Lacan, the schools of psychoanalysis applied to psychosis or as mentioned above, the world of children.

Graphical activity thus took on a certain significance, gaining a place within an organised body of psychoanalytical knowledge. At the same time, however, it was also treated as an adjunct, unlike the specificity long accorded to verbal expression. Of particular interest were the studies of the origin and development of the graphical symbol, which at times revealed a slow metamorphosis: a sign became “other" until it configured itself as a symbolic representation that was subsequently elaborated. In these cases the content of the symbol could be read in terms of the object representation from which it was drawn. A mad painter thus emerged from the traditional environment of the hospital atelier. Psychoanalysis deconstructed the location of pictorial activity, reducing it to the locus of the psychoanalytical setting. Although the hopes of the first two strands of investigation were not realised, this third line of enquiry remains alive and, in certain aspects, it represents the surviving use of psychopathological expression.

There remains the problem of place, i.e. where the work was to be produced. Traditionally, this was done within the studio, usually with a group of persons that would come together for a few hours from the various wards of the mental hospital. These art studios had developed systems for the collection and storage of materials, in order to enable serial analysis of the work, following the dynamics of its development, with all its changes in style and representation, rather than limiting analysis to individual works.

In the last fifty years we have seen the gradual closure of the mental hospitals in Italy. Those that survived have seen their size reduced, number of patients reduced and stays shortened. The ateliers thus lost much of their significance. The mentally ill are now handled by a network of mental health services, where they can move from one unit to another, destroying the continuity of graphical work that in some cases had lasted for years or decades over the span of their stay in the hospital. These developments in institutional psychiatry have been accompanied by a change in the way the mentally ill are treated. There has been elimination or reduction of the role of the atelier and the increased emphasis on the psychoanalytical setting, in which any activity is conducted within that setting and is thus tied to that particular moment, with no systematic cataloguing of the work over time. Given that the role of psychiatric institutions will continue to diminish, this use of graphical activity could well come to dominate.

This is the starting point for a new development that keeps alive the hopes of those convinced of the value of long-term graphical activity: art therapy. This new approach to using non-verbal communication is completely different from the traditional, moribund, strand of the psychopathology of expression. It focuses on achieving a therapeutic result using every available instrument, including graphical work. Under this approach, drawing regains its function as a liberating and therapeutic activity in the various settings. Art therapy is based on the psychoanalytic use of non-verbal language but simplifies its interpretative methodologies. In fact there are completely empirical schools of art therapy or group art therapy, while others make no reference to psychoanalysis whatsoever. Art therapy has come to dominate the field of non-verbal communication in a number of countries, especially the Anglo-Saxon world. Obviously, we are talking about completely methodological approaches, both as regards the long years of work in the hospital ateliers and the analytical content. Nevertheless, it is probably the most promising sector of endeavour, although in our view it needs more solid structural foundations than easy empirical enthusiasm. These, then, are the major strands of work that recount the story of SIPE.

Let us now look back to 1983, a landmark year in the Organisation of studies in this field. SIPE was an independent grouping, whose work was enriched by the contributions of historians and artists, with other input coming from graphologists, philosophers, art critics and psychiatrists. There was a risk that it would stray from the field of psychiatry entirely, and with this, any medical and scientific foundation. For this reason a group headed by Robert Volmat (the long-time president of SIPE), decided to apply for recognition in the World Psychiatric Association (WPA), asking that the psychopathology of expression be accepted as a Section of the WPA. This request in a sense represented a return to the origins of the field, given that the 1950 exhibition was organised under the auspices the First World Congress of Psychiatry, and SIPE itself had been established in Verona with a typically psychiatric orientation.

There was a feeling at the time that it was essential to bring this field back within psychiatry, to involve researchers within the framework of the international psychiatric community. They were years of crisis for SIPE with poorly attended conferences, lack of funding for an international publication devoted to the field, and so on. The president of the WPA at the time was Prof Piseau. For Volmat, dealing with a president who had long expressed an interest in non-verbal communication was a dream come true. Piseau readily accepted the proposal and worked to convince the leadership of the organisation of its validity. At long last, the psychopathology of expression became a section of the WPA, complete with a statute modeled on those of the other WPA sections.

The psychopathology of expression section thus had an enormous opportunity to present its own symposia and conferences and disseminate its studies and research. The field could now stand on its own among equals in an arena without parallel. By way of example, the last World Congress in Madrid was host to 10,000 psychiatrists. It was now possible for the psychopathology of expression section to take an active role in world psychiatry, helping to stimulate interest in non-verbal communication.

Thus, since 1983, there have been two organisations involved in this field; SIPE, which has continued along its traditional path, and the Section for the Psychopathology of Expression of the WPA, whose efforts are more tightly focused on clinical psychiatry. The two bodies are not redundant. The statute of SIPE, which is the product of a long and independent history, provides scope for work on the most varied issues in a broad cultural context, while the Section for the Psychopathology of Expression of the WPA has a narrower focus on psychiatry and its problems.

A problem that needed to be addressed within the WPA was whether an exclusively psychiatric section could alter its foundations. This is why we requested that members of the psychiatric therapy team without medical training be admitted. In other words, we wished to open membership in the section to psychologists. Nevertheless, its psychiatric identity is very strong, an essential condition for continued membership in the WPA.

It is to be hoped that these two bodies can continue to function independently while maintaining their fundamental integration. Those who would argue that one or the other is superfluous are wrong. They have a poor grasp of the history of the field and thus misinterpret the great achievement of 1983.

Any history of the psychopathology of expression must include an account of the congresses of the WPA, which have served as a stage for the graphical world of the mentally ill and non-verbal communication. This year's Hamburg congress is an example, playing host to four symposia on the psychopathology of expression in addition to the exhibition that is the subject of this catalogue.

At this point, however, we should return to an issue that we have mentioned only in passing. That is the purely artistic interest of the work of the mentally ill. We noted the shift in emphasis from ”art” to “expression" in the early stages of the field's history. It was argued that the psychiatrist is not competent to issue an artistic assessment of such work. This cannot be the end of the story, however, even if we only wish to argue that it would be unjust to exclude a priori the possibility that a person suffering from mental illness could produce a work of art. From a theoretical point of view such a restriction is untenable. Recall Cesare Lombroso, who argued the very opposite, i.e. that the madman is favoured by his condition because he lives beyond the rational world, because he is detached from the quotidian, and therefore can directly tap the freedom that is necessary for creation.

A psychiatrist has the right to ask that the art critic assess the works produced by the mentally ill without reference to the background of the painter, which could otherwise channel the response into the standard framework of the incompatibility of art and insanity. Obviously, the madness of the author should be considered but it should not be allowed to affect the aesthetic judgement. This is important because the incompatibility of art and madness has been sustained not only in abstract treatises on aesthetics but also in the real world, with such work being denied exhibition space and ridiculed. I do not believe in any necessary connection between art and insanity. However, neither do I believe that we can argue that creativity is ruled out by or dependent on madness. The hospital studios have never been considered the best schools of the time, but we cannot deny that some patients have achieved a high level of creativity, earning the praise of the broader public. The psychiatrist cannot evaluate the artistic value of a work. At best he can decide to hang the work in his home. Still, he can insist that those who are qualified to make such a judgement use the same measure to assess a work by a person suffering from paranoia in an asylum as they would to judge the work of an authentic bohemian. There is nothing to exclude the possibility that the most insane person might express himself artistically.

In this regard, we should now examine the phenomenon of art brut. Art brut emerged as a movement around 1940-41, the creation of Jean Dubuffet, who decided to collect the works of art produced by artists brut, i.e., people who produced what he called ”art non culturelle". These were artists who had not been trained in the academies or in the studio of a master artist, who did not belong to what he called the ”asphyxiating culture” of art. These were the beginnings of the collection that after the war found a home at 137 Rue de Sèvres. The Companie de Art Brut was composed of a small group of close friends, who were the active, decision-making members of the company. As a member admitted in 1966, I was thus able to follow this other strand of work produced by the mentally ill. In fact, 85% of Dubuffet's collection was work produced by the mentally ill. In other words, his definition of “non culturelle" and art was closely linked to mental illness.

When in the early seventies it was no longer possible to keep the works in their original home, there number having increased considerably, the Compagnie de l'Art Brut decided it was time to establish a permanent museum open to the public. The idea was to create an art museum largely dedicated to the work of painters who had experienced madness. The Compagnie decided to donate the entire collection to France, asking in return for an appropriate site and a commitment to continue the collection. The Government of the time rejected the proposal out of hand, influenced by the painters' union, which argued that the insane should not be confused with real artists. It was a grave disappointment to discover that a world we had thought would be more open-minded the, ”creative world” was instead ignorant and prejudiced.

It was then decided to offer the collection to another country as long as the basic conditions were met. The City of Lausanne made the offer that most closely matched our wishes and the collection of art brut was ceded to the city, which continues to manage it very well to this day.

I was the only psychiatrist in the Compagnie de l´Art Brut, with the exception of André Breton, who was trained as a psychiatrist but did not practice. The group was formed of artists and others from a wide variety of cultural, humanistic and philosophical backgrounds. I mention this fact because art brut became associated with insanity. It was in a certain sense a response that a psychiatrist could request of someone in the art world to look at the work of the mentally ill produced in a hospital art studio in Mont Martre or New York and apply the artistic criteria you normally use to the work.

This attitude led to the discovery of a number of good artists among the mentally ill and a very small number of geniuses. The three most impressive are Aloise, Adolf Wölfli and Carlo Zinelli, who have rightly received close attention from the art world. In fact, Zinelli is recognised as one of the most significant painters of this century.

Clearly, the issue of art in madness requires many distinctions. There are painters who have gone mad, mentally ill persons who had never painted before entering a mental hospital and painters who painted both before and after the onset of their illness, demonstrating differences in style and manner between the two periods. Dealing with all of these is far beyond our scope here. Accordingly, we shall continue to focus on art brut and the efforts of the Compagnie, which deserves praise for following through with an intuition that has led to the creation of a collection of highly significant works that would otherwise have been lost. It brought attention to an anonymous world and found a place for some in the world of ”Art”. This is a major achievement, both in terms of the creativity it unearthed and the humane approach it embodies.

However, it is not possible to be entirely satisfied with the approach, which should now be more of historical interest than anything else. It is still important but with significant limitations in relation to our needs today. If the mentally ill produce work that is artistic, then this work is art. There is no need for any modifying adjective. The meaning of “cultured" or “uncultured", "cultural” or "brut" was already highly debatable during the movement's period of greatest enthusiasm. It is even more suspect today. We cannot automatically call someone with a low level of education "brut", because he may well be highly cultured in other ways. By the same token, this adjective, which proved very powerful at the time (leading as it did to the creation of a movement and a museum), cannot represent a category of art. We must go beyond such classifications and speak of art alone. Hence, no special museums and no more absurd rules that prevent an artist brut from selling work, because the market was considered a degeneration and falsification of art. In fact, it is hard to understand why Dubuffet the painter could belong to the world of art and have his work shown in museums, while the artist brut had to remain outside. This is a form of “ghettoisation" that must be banished.

If we wish to address the problem of art in mental illness, we must discuss art alone, as it exists at that moment in time, without absolute definitions. The work of the mentally ill should be assessed by the critics of the time, applying the criteria that are used to judge any other work regardless of provenance. If the work meets certain criteria, then it is art and should be treated as such, whether this involves being sold in the market, shown in galleries or hung a major museum. It must no longer be restricted to Rue de Sèvres or the Lausanne museum. The latter is worth maintaining as an example of helpful, but dated, archaeology. I cannot say if the works exhibited in Hamburg at this year's World Congress and published in this catalogue are art or not. I do ask, however, that those who are qualified to make such an assessment do so without prejudice regarding its origin. If it is indeed art, let this evaluation speak for itself, avoiding additional adjectives that serve only to diminish, isolate, or denigrate. This issue will become a matter for discussion because it is an area that is not directly part of psychiatry but which nonetheless contributes to psychiatry. It reminds us that insanity is not a wasteland of degeneration, but in fact retains enough humanity even to aspire to Art.

 

 


 

PSYCHE & KUNST

Chapter 3

 


IS THERE A CONNECTION BETWEEN THE CREATIVE PROCESS AND THE MENTAL STATE?


SYMPTOM AS CREATIVE EFFORT


By Gaetano Benedetti, translated by Bert Stibbe




The creative effort linked to certain mental states is recognized as a valid concept in two areas: The first is in the psychopathology of expression in which the creation (e.g. painted/drawn pictures) of the patient is seen as an "act." The second is from the viewpoint of Dynamic Psychotherapy when the symptom of the patient is experienced as a symbol. Both expressions are in fact connected.

The psychopathology of expression comes from the patient's mind even if noted outside psychotherapeutic intention, while dynamic therapy recognizes the symbolic expression of the ill person. Psychopathological symptoms may however, be both creative and non-creative. Often no creative work appears because it originated in that part of the brain where the spritual-mental life ceases to exist because the fight has been defensive or the defenses against mental illness have collapsed. After all, how can creative work come into being with a mind that is paralyzed, resigned, emptied, fragmented or ossified?

Certainly many psychiatric symptoms have a purpose. This was recognized in the last century and became more certain after Sigmund Freud. In the realm of psychosis it is also known that many symptoms do not guarantee the patient's psychic survival. One only has to remember the rigidity of insanity which dissolves personal identity and becomes immutable as if the patient assumed a new identity for himself.

Searles (1965) noted how some patients during the course of many years formulated their uneven mental outlook. With this observation he wanted to humanize the chronic mentally ill. Yet artistic work and identity, while productive, do not necessarily mean authentic creativity. This only happens when a patient despite his illness takes a step forward in an attempt to overcome the illness. Only when this situation is recognized are we able to properly communicate with the patient in a creative manner. In the pathological realm creativity is only reality when the striving is toward communication versus autism, and positive views versus negative narcissism.

I use "versus" instead of "opposed to" because a minus polarity is never absent. In attempts to overcome there is always rejection, and in progress always regression. Sorting through and identifying these strains is not always exact and definitive. Like physicists, we psychiatrists have learned that the "watcher", in some degree influences the "watched." Only our specific participation influences the dynamic direction and positive outcome.

In the reception and interpretation comes the second act so to speak. The effort of both patient and therapist results in the power of change. The direction of such change depends on the transforming power - coming from a "minus" into a "plus" situation. Initially this may be evident in the positive projection of the therapist, yet at other times it comes from the patient and may even have a creative effect on the therapist.

Since I have devoted many years to the problem of psychosis I now would like to give a historical summary as well as my experience in this area.

THE PSYCHOPATHOLOGY OF EXPRESSION

This subject presented by Prinzhorn (1922) taught us that psychosis can be creative in verbal and in actual picture presentation. While drawing or painting a picture, a psychotic patient can develop a language which can be more revealing than verbal expression. Often it appears that the patient is able to communicate better through pictures, while verbal communication may not be logical or realistic even causing estrangement, hence, the picture may be closer to reality.

Another hypothesis (Bader & Navratil, 1976) is the dissolution of the "me" and new attempts for "integration" are made. Yet, is this creative? Is the schizophrenic neomorphism only a diversion as often mentioned in contemporary accounts, the beginning schizophrenic "art?"

The well known Italian phenomenologist Barison (1993/94) objected to this formulation. He stated that autistic patients are unable to form the "human" connection and unlike the true artist are unable to connect rationally to the surroundings. His is one opinion, but is all non-rational thought process always negative? And how about the curious originality (Navratil 1972) which seems to come from the psychic process?

With these ruminations we arrive at the second act of creative work which we will call "reception." It is our reception which decides whether a psychotic expression in pictures is creative or merely psychotic. Further, it is our reception which retroactively spurns the patient on to new works which may heighten his quality of life or acknowledge its’ isolation. It appears that psychiatrists are the ones who usually see ambiguity in both objectivity and subjectivity. This century has seen an increased "reception" of the psychotic picture phenomenon by both psychiatrists and lay people.

In my practice the leap from words to pictorial presentation can definitely be categorized as "creative." But at this moment I will not apply my theory to the psychotherapy realm, but will focus on the "psychopathological expression" in a particular case. I will return to the psychotherapeutic aspect later on.

Case Study

While psychotic, a female patient painted three episodes of her life. When contemplating her pictures she realized that not only did she experience fear and negative emotions in her mental illness, but also a certain inner strength which was not previously apparent.

She realized that up to her 25th year (her time of 'normality" in which she completed her university studies in chemistry) her paintings were without color. While ill, however, she painted in color, i.e. during her "second life phase." In the later illustrations - while chaotic vs. the earlier "orderly" pictures - she portrayed herself as "dead."

I suspect that this realization of hers was partly possible through the "psychopathology of expression" without the assistance of a therapist. I further believe that her self presentation is somewhat exaggerated - i.e. not really representing her past. There is too much projection of her negative past. In later therapy we discover that her past had many positive experiences. Still it was important for the patient to depict her past as dark, yet painting it in vivid colors - as if to negate her psychotic state. This was a creative impulse which pointed to the third phase, that of healing. This was a prophetic sense of the unconscious future. Healing of her illness happened a few months later.

This triptych demonstrates that even though most of her life was an existence of mental illness, she saw herself in the middle of life, and she begins to find a certain order and new identity in herself.

Dynamic Psychotherapy

Now I would like to discuss psychotherapy by means of three symptoms in the creative effort:

a. Progressive psychopathology

b. Transference

c. Creative aspect of transference Progressive Psychopathology

A patient believed she lived in an "insane labyrinth" which consisted of tubes and pipes. These tubes seemed to be like man-eating plants which sucked the blood from the patient and became a monstrous circulatory system. This labyrinth also served to connect the patient to the cosmos but could not nourish (with her blood) this cosmos and was thus on the road to death.

At first this seemed to be an extreme case of narcissism (an inability to love), i.e. it was impossible to "supply" the world with love because she saw herself as a parasite (in the machine of tubes). In the course of therapy the patient began to distance herself from her negative feelings and desired to "give" something to her therapist. At times the patient saw her therapist a feared "plumber" amid the tubes. This is deemed progressive because the therapist is placed in the "labyrinth."

The patient then wanted to collaborate with this "plumber" in order to give this mechanical labyrinth a better course (for humanity). After additional therapy the patient asked whether the machine could be changed in a fashion where the blood would be "returned" to her. "And could the therapist donate some drops of blood so that hers (the patient's) would not be poisoned."

Throughout these interactions the therapist guided the patient through this imagined machine toward a measure of subconscious self-therapy.

This short case study demonstrates what I mean by progressive psychotherapy. It does not mean that a clinical improvement is being reached, nor that the psychosis and hallucination is disappearing, but I see this situation as an antipsychotic "intention."

Schizophrenic patients are confused with their surroundings and with fellow humans. Psychiatrists such as Bleuer (1911), Rosenfels (1969) and Kohut (1973) have analyzed situations and the means which afford some psychic ease for mental patients.

A principal factor for patients is the transference or transformation of the respective mental illness. The therapist recognizes the patient's emotions and situations and symbolically integrates these with his own. We see this even in psychiatric care situations (outside psychotherapy).

When I was a student, caretakers told me how patients with persecution complexes thought that the caretakers were likewise persecuted. I noticed that this was true only when a positive climate existed between patient and caregiver. In contrast to Rosenfeld's "projective identification," I call such phenomena "introjective identification," i.e. a first step in a life of duality.

Here symbiotic situations are central. They are indeed so important that Searles (1965) coined the phrase "therapeutic symbiosis". Many authors found this confusing since childish symbiosis, which apparently is the basis in schizophrenic development, is always pathological, while therapeutic symbiosis, with proper application is seen as developmentally positive.

The question now is can the resultant "self object" from this symbiosis become creative in itself, so that there is not a fusion of persons, but a dualism of the two persons as separate though still related? This possibility I will label the "transformation/transference subject." I believe this is creative in the patient because it stems initially from the self-object and then gradually changes the mirror image into the "you". Thus the negative self-image is changed through this interchange of the mirror image. Just as the therapist identifies himself with the positive aspects of the patient, without surrendering the I-you boundary, there is also a reverse: one goes "across" to the other.

Case Study

A schizophrenic patient was under illusion of sin and redemption - family members often said that her evil nature could be seen in her eyes. In her mental state she imagined that the devil was in her eyes and she painted a picture of herself in this state. It took some time before the therapist as able to discover positive aspects in her personality - such as constructive aggression in which previously only the "devil" was evident.

The most dramatic episode occurred when she envisioned herself as the "devil sculptor," attacked her work with a scalpel, not to damage her art, but to give it a new identity.

Now the patient began to realize that this devil was no longer a metaphysical entity in her psychosis, but another part of her own personality which now was rehabilitated and failed as a creative function.

Soon thereafter the patient stated that the artist (devil) was merely herself - namely the patient who earlier "attacked" her (while struggling with the negative identity) but now helped her to be the person she wanted to be.

Both identities were the transference object, the "I - you" duality. There are cases in which this transference object only slowly assumes the self-identity, i.e. a newly discovered part of self-identity -yet not the "I" of identity as we find with patients hearing "voices."

The change from patient to therapist may be surprising and somewhat disturbing. Is the therapist bearer of the symptom? Surely not in the clinical sense. However, it is anthropologically significant when "symmetry" results from the therapy where significant asymmetry initially existed between patient and therapist.

I would like to discuss two areas - first, the therapeutic dream, and second, the negative emotions of aggression, fears and helplessness.

Dreams of psychotic patients are often not merely transference dreams in the usual accepted sense - those in which earlier problems of patients are analyzed (although this does happen). The new insight for me is the "positive working of partial symmetry," which is evident in regular therapy sessions or happens as a subconscious act.

I will relate three dreams which I analyzed with patients.

Case Study #1

A schizophrenic patient had raped his mother and killed her. The patient then was in complete denial. He developed an illusion of redemption - he was the messiah who would bring peace and salvation to humankind.

This mental state was exceptionally strong and appeared without hope. Then a therapeutic dream happened. The therapist dreamt that he killed his own mother (without sexual overtones). While still dreaming, the therapist knew that this killing-fact was an impossible act, just as the patient declared it in his denial.

However, people in the dream convinced the therapist that the deed was indeed fact. After awakening the therapist realized that this was a "mirror-dream." The dream put him in the patient's place so that he could provide insight into the denied deed.

On my advice the therapist related this dream to the patient without, however, attaching any explanation to its content. I add that this dream had insignificant relevance to the therapist or to his thoughts about his mother, but was a compensatory mirror-image of the patient's dream.

Upon hearing this dream the patient was completely thunderstruck as he now remembered his past. This was the first significant step from the "magic" to the "tragic" - as Wurmser (1998) formulated in his presentation in Lindau. But now the patient became extremely depressed. The depression could be treated however, whereas the previous psychotic state was a therapeutic dead end.

This therapeutic dream, while a symptom of "over-identification" with the patient caused anxiety for the therapist. The symptom, however, was a creative act because it demonstrated to the patient that the therapist was willing to take his (the patient's) place.

Patients cannot be told every dream. Another example demonstrates the psychopathological situation of the therapist - again as creative act.

Case Study #2

This concerns a chronic paranoid patient with a persecution complex, said persecution being instrumental in not finding am ideal mate. The therapist was able to gain her confidence and explored the patient's desires, guiding her to confront the disappointing reality.

During the therapy the therapist dreamed about her patient: she saw the patient persecuted/followed by people (and this not in the patient's psychic state). In the dream the therapist did not know that she was treating a patient; the patient in the dream was no longer ill, instead she was merely a persecuted (normal) person.

In this dream the persecution appeared an exact copy of the psychotic persecution illusion. In the dream the therapist feared for the patient and she attempted without success to warn her patient of the persecution. When she awoke she understood the patient's illusion.

She did not relate the dream to the patient, which would presumably deepen the psychosis. Instead she asked herself "Did I over-identify with the patient?" The therapist could only say "yes." The result was that the therapy became more effective and the patient lost her psychotic delusions.

The affinity of therapist vis-a-vis the patient defines am effective self-sensibility in that the therapist "experience" had to be overcome. The creative act results in a positive outcome in which the therapist responds to aggression with loving counter-aggression. In other words, the therapist internalizes the patient's aggressiveness and rejects only that aspect of the patient which blocks communication.

All this can be repeated in a dream because dreams: create "distance" between both parties. It is interesting that therapy can be effective even when the dream is unknown to the patient.

Case Study #3

We now note a therapist's dream in which he killed his patients. Being part of a control group, his colleagues were not-impressed with the dream and noted that it merely reflected the individual's narcissistic weakness. The therapist admitted as much, but continued the debate that in the dream (not told the patient) the whole person was not to be killed, rather an intra-psychic persecutor (had to be eliminated) whose victims were both the therapist and the patient. Both dreams of therapist and patient happened in the same night. Immediately afterwards the patient's condition improved.

Such phenomena are difficult to understand. "Felix qui potuit rerum cognoscere causas (Happy is he who recognizes the cause of phenomena)." Thus sang Vergil in his "Georgica" 2000 years ago. But the main human motivation sometimes is deeper than any hypothesis may reveal and as Nietzsche stated, the recognition of the other is older than the recognition of the ego.

My final thought: Even if Vergil's happiness is not always possible in psychotherapy where human suffering is often resistant to and sometimes impossible, an expectation of this happiness is possible in that instance when psychotherapy creates a change of evident healing

. Strobl_Heidemann_Final


 

 

 

Psyche & Art
Chapter 4
 


ARE THERE PSYCHOLOGICALLY DETERMINED ART STYLES THAT ARE INDEPENDENT OF CULTURAL INFLUENCES? 

MECHANISMS OF FORMATION AND CHARACTERISTICS OF EXPRESSION IN THE ART OF PSYCHOTICS.

By Rainer Strobl, translated by Ilona Heidemann

"The Austrian daily newspaper Die Presse published the following article upon the first landing of a man-made robot on Mars:

Humans, both as individuals and as a global human collective also need the irrational - which is not grounded in practicality. Humans as individuals need the luxury sports car, and designer clothes. As a collective, we need pyramids, cathedrals and baroque castles, and today mankind needs little robots which can meander on Mars."

Isn't such an enterprise "crazy" when mankind is currently facing problems at the end of the millennium which affect it directly: which are causing suffering for millions of people and conjure up apocalyptic sentiments due to the absence of solutions?

About 2000 years ago Seneca wrote: "Genius has never existed without a bit of madness" (Bergdolt 1995). When we express exceptional things in our everyday language, we often use psychiatric terms: "You look terribly good",  "that was mad”,  "I am crazy about you", etc.
 
The extreme, passing of limits conceptually is attributed to the semantic aura of insanity.  Progress is the catalyst for human activity; it opens our space for life and activity from the immediacy of the "real" given facts into the immediacy of unimagined reflections.  

Progress distances us even in the cognitive evolution (i.e. the individual, phylogenic and cultural development of human knowledge) from the mere subjective-magical (ptolemaeic) point of view via the Copernican turn into the abstract world of rational-generalizing thinking (Strobl and Resch 1988). Trading for example has changed from exchanging goods by means of money (object replacement) to a  moneyless transaction (virtual).  Progress leads to limits , which one has to overcome, or exceed, but which can cause failure, as well.  

Exceeding limits may enrich one's own living space but it can also lead to alienation or exclusion, to aberration, and finally to a point of no return.  Thus the human individuality as well as his cognition is linked to finding identifiable solidarities and distinguishing differences, to observing and "shifting" limits. This balancing act at the borders of our existence, be it of substantive or mental nature, is fascinating, unusual and uncommon.  It moves in the sense of "progress" but is also risky. There have always been scientists, adventurers and explorers who lost their lives or their homelands.  There have been philosophers, poets, composers and painters (Wrubel, Dadd, Hill, Josephson) who went mad searching for the "inner" reality (Roth 1994).

Genius and madness, art and delusion have nothing in common, they are exclusive more than giving rise to the other.  However, they both reside in the same place; in the borderland of our souls; in the area of the extreme and the unusual.

In this sense Aristotle, for example, did not generally consider artists who are prone to delusion (melancholia) as mentally ill, but rather in jeopardy because of their sensibility and disposition to eccentric behavior.  In contrast, the artist's "sensibility" turns into artistic performance, whereas the sick person’s illness ends in breakdown.  Plato differentiates the pathological mania from the "mania muson", an exceptional state evoked by the Muses, which pushes the artists from the daily world  ("Technai") into the world of creativity and elevates them from everyday life. (Bergdolt 1995).

"Emerging" from the shackles and from the banality of everyday life, the desire for the new and unknown has led mankind not only to explore the domains of their outer world microscopically and telescopically, with deep-sea diving and high altitude flights as far up as to moon and mars.  It has also brought about the search of domains of consciousness hiding beyond the reality of our psychic landscape.

Before the phenomena of altered states of consciousness were classified as psychic abnormality and illness, people thought of them as being prophetic, holy and divine or demonic and diabolic.  The mystics of the Middle Ages tried to enter the world of "psychosis" artificially in order to experience hallucination, inspiration and a changed self- and reality-consciousness (Reha 1938).  Searching for another reality, by escaping the more than odd and unbearably stressful reality and entering insanity, by consuming drug induced "exceptions", as well as marketing of "journeys into the inner world" are important to the global economy.  Compared to these uses the high costs for general health and social care caused by schizophrenic diseases play a rather small part.  However, given the fact that only 1% of the population is affected by schizophrenia the costs for treating schizophrenia are comparably much higher than other diseases.

Experiences of delusion are not necessarily pathological. They occur in psychic exceptional situations like overstimulation or isolation, ecstasy, affective restriction, abnormal stress, change of consciousness, influence of drugs and especially in psychic diseases, like schizophrenic psychoses. Each strong agitation is already a state of exception but can not yet be designated a disease. Similar to a state of drunkenness the acute schizophrenic psychosis transforms the reality of the consciousness of everyday life into that of dreams and fantasy.

While there are people who actively enter different states of consciousness, schizophrenics plunge into them because of neuronal dysfunctions, which lead to a neurobiological state of exception. Similar to a deep-sea diver, schizophrenics may experience a "deep-sea ecstasy" with a loss of orientation and an aberration in the "labyrinth" of the soul.  Without help there would be no return for them.  People with "depth" such as artists or people with a predisposition to schizophrenic diseases more often suffer shipwreck. Schizophrenic people are vulnerable due to an allergy like hypersensitivity of their emotional structures so that they suffer recurrent breakdowns.

This causes the patient's consciousness to be flooded by the magic-archaic world of the subconscious and subsequently the relation to reality gets lost. The disease plunges them into the depths of consciousness, which the "normal" person can not experience despite stimulants or "imagination". The well known German philosopher and psychopathologist Karl Jaspers provided the following answer to the question about his feelings for Van Gogh and how he felt about the works of his own schizophrenic patients:

"It is as if the last source of existence temporarily becomes visible; as if hidden reasons for human existence are told." (Prinzhorn 1922)

It is therefore not a question of  being healthy or ill, and not a question of the border between normal and abnormal.  The matter is our "psychic landscape", which is part of our very identity despite its uncanny and mysterious strangeness. The landscapes of our inner life are objects of artistic works just like the landscapes of our environment.

If we commonly define art as the ability of mans’ subjective impression of his outer and inner reality, it is extraordinarily pertinent as he experiences it with his senses and his cultural and historic background using different methods.  Art is a medium to design in the sense of progress, the directly perceptible world by means of fantasy and creativity and to enrich its diversity. (Strobl 1997)

Delusion is also extraordinary, and results from fantastic descriptions of a subjectively experienced world. It can also be depicted in works of art. In fact, delusion is a regression, which is accompanied by restrictions and limitations. Disease leads to a loss of function and performance; it interferes with the artistic constructivism and creativity. Delusion is not a primary symptom but a psychic reaction to a biological as well as psychic inability of man to cope with the requirements of reality. While art, creativity and invention are the expression of extraordinary performances and form our environment with their creative power, delusion is a non-differentiated substitutional world, a reduction.

Schizophrenic illnesses, especially the chronic forms, lead to a disintegration of personality and thinking processes so that the sources of creative abilities can fail over time. The representation of the psychotic landscape of the soul can be an artistic task but few schizophrenic people succeed in going beyond the banal, unpracticed and unskilled performance  to give artistic value to that representation.  Most images do not meet the academic criteria of art but they appeal to us because of their strange peculiarity; their apparently naive originality.

Contrary to art, which presents reality in forms of symbolism and imagery, delusion portrays reality itself.  Similar to the archaic thinking of "primitive" people who identify picture and reality and in case of damage "magically" destroy the object, delusion is the immediate realization of hope, of fear, and therefore of fantasy.  The artist produces an imaginative representation of reality, while the delusional patient lives it directly. This "genuineness" of delusion holds the fascination of authenticity and of immediate concern.

Like landscapes of the ancient world with their excavation sites are of interest to archeologists, art of the falsely accused as "insane" schizophrenic patients were developed as a matrix for the study of the history of the human psyche .  This study has exposed hidden parts of consciousness and of the beginning of what has become culture and art. Mankind has gained substantial insight into invisible processes of human visions and dreams by observing the psychotic adventures of recovered  patients, healthy people who only stepped to the border of psychotic "depth", and schizophrenics who were, and are, able to describe authentically the impressions of their morbid alterations of experience. Salvador Dalì underwent the adventure of induced insanity, reversible delusion and controlled schizophrenia (Reko 1938). For Dalì delusion was not a disease but an instrument for the achievement of extraordinary pictures. He wanted to be captured by delusion, but he wanted to control it critically at the same time and not go insane.

As the psychotic disease impairs the core of human life, the psychological functions and thus the structures of our world of experiences, it causes anxiety in us. For this reason the social community avoids dealing with this subject. Patients withdraw into a shadowy existence because they cannot cope with the impressions of their environment due to their "seismographic" oversensitivity. As fools, maniacs and madmen they lose their human dignity, which pushes them even closer to the edge of the community.

Schizophrenics seem to be extraordinary as well as strange. This discrepancy between cryptic "farsightedness" and "stupid" conclusions (an anticipated danger is judged as being a present danger) has a paradoxical effect. It is strange to say that we think of them as "schizophrenic" because of their inability to analyze a contradiction. Schizophrenics tend to consider  the opposite in everything. They do not split the detail from the whole. Because they do not divide elements of individuality and commonality everything fits together: differences between collective and individual, conscious and unconscious are mixed and the past is equalized with the present. Everything is merged. They are part of the world and the world is part of them. Thus their field of experiences becomes a mirror of themselves. They identify the human destiny as their own and their fear of death becomes the end of the world. They are "narrow-minded" because of their infinity, foolish in their diversity and they appear imbecilic and stupid. Schizophrenics are not fools; they only act like fools. They are not stupid; they get their insight from the depth of their soul. In their "foolishness" they violate conventions and surprise one with their eccentric originality.

Schizophrenics are vulnerable in their frankness and thus also suspicious (paranoid). They are constantly "alert" and react to the smallest "sign" (Roth 1994). Their need for precaution impedes their ability to see the bird's eye view. Their "ego" suffers, comparable to an immunological deficiency. From this deficit of resistance they cannot differentiate between 'alien' and 'self' and are helplessly exposed to inner and outer influences.

The "psychological skin" of schizophrenic people is thin, similar to cracks at the surface of earth which allow the outflow of glowing lava from the inner erupting volcano (acute psychosis), which then gushes out of the deep inner part and flows over the usual reality landscape of their soul (Prinzhorn 1922). The images of schizophrenic patients show us the depth of our consciousness and thus elicit an understanding of psychological structures. Pictures of  such  psychotic inner life terrify and affect us. Dealing with them allows us to see the labyrinth of the human soul from different perspectives. It helps us to understand both the world of the schizophrenic as well as our own.

Schizophrenia is caused by malfunctions of the brain, which consist of an increased neuronal activity and thus lead to the disintegration of archaic structured thinking processes. As rational thinking is no longer possible the ordinary world of experience loses its "structure". In order to compensate for this loss of structure, archaic reactions are reactivated. Delusions, hallucinations, oversensitivity and  overstimulation, thinking and emotional disturbances as well as an alteration of self-experience, of psychomotion and vitality are the main symptoms of the illness.

As the cerebral cortex "sleeps" more deeply, the dream may get the character of reality and the subconsciousness enters the field of our experiences. By the reduction of the everyday consciousness the experiences are led by subjects of the subconsciousness, by the world of magic. As self-consciousness is bound to the ability of reflection it can get lost on the way to the subconscious which may result in a withdrawal from self-intention (control) and devotion to mechanical thinking processes of the unconscious.  This can be observed in dreams and under the influence of drugs. Those automatisms, which seem to occur "accidentally"  without  the control of the self-consciousness, are often seen in scribbles and chaotic paintings. Only consciousness allows us to put together the pieces and then interpret it as a whole.

When the psychotic patient is in the subconscious, intellectual issues are blurred and thinking becomes descriptive and is determined by affect and intuition (Lange-Eichbaum u. Kurth 1927). The contact with the collective subconsciousness leads to a "globalization" of individuality. Thus a patient for example feels responsible for the destiny of the world and concludes to be "God". It is this merger of the collective world-consciousness and the cosmos, lived during psychosis, that suggests the subject matter of schizophrenics deals with explaining the details of the universe. It also explains the extreme intensity of such universal experiences that affect the patient. The elemental power of human existence, that boils like glowing lava under the earth's crust and which on eruption exceeds the emotional capability, leads to insanity. This is often reflected in the impressive style and in the weird atmospheric pictures of schizophrenic patients. Even descriptions of emptiness  with their deep expression cause a responding dismay.

Psychotic impressions are more emotional, more dreamlike and more complex. The increased, oversized ability of perception and experience in the state of psychosis is expressed in strong colors and style. As the fantasy of the inner world is equalized with reality it represents the authenticity of the immediate experience.

In the morphological disintegration of psychotic thinking, logic does not follow the continuity of rationale but the momentarily experienced main significance of single features. Thus things join together, combine with one another and can replace each other. The objects which are both themselves and something else melt together to a whole and at the same time split into fragments. The detail becomes the whole and vice versa. In the so-called prelogic-predictive thinking one of many features of an object replaces the whole. Thus two objects can be identical if they have the same feature. A dog is real; I am real; so I am a dog (Strobl 1990).  

Predictive mutualities of psychotics can bring secondary aspects to the forefront and give them the main significance. Unconscious minor associations move from the background to the foreground of the conscious. By mixing foreground and background, conscious and unconscious, the concealed is overestimated. As schizophrenics have an intuitive understanding of  connections, they are superior to healthy people in this respect in that they enlarge their  field of perception through the draft of the detail which achieves a higher meaning in face of the whole. This explains their "seismographic" sensibility and their farsighted anticipation of causes behind the curtain of "normal" reality. Scientific studies have shown that schizophrenics take far more options into consideration than healthy people do. This explains their proximity to limits and  the transgression of them.

The equality of both detail and total (pars pro toto) for schizophrenics also explains why a symbol achieves the meaning of  coded overall content and why the description, whether symbol, sign or picture, becomes reality itself. The reduction of  pictorial, symbolic and abstract-linguistic descriptions transposed into the metaphoric to the concrete level of the originally "comprehensible" world is called "schizophrenic concreticism " and is a key to understanding psychotic experiences (Strobl 1990).

Visions in the form of hallucinations obtain the real character of perception: thoughts become pictures, pictures become reality, thought is equalized with action. The meaning of words transposed into the metaphoric achieves their original sense.  They are taken "literally" in the true sense of the word. The development of  writing from figurative language is hereby reversed. Therefore, in the pictures of schizophrenics scribbles, writing, symbols and pictures are often used simultaneously as forms of description.

There is no "metaphoric" transference of meaning between the "concrete" original and the "comparable copy" (symbolism) and it leads to the loss of the "as-if" quality. Thus a schizophrenic can think of himself as a glass because he feels as breakable "as" glass. The wondrous creatures of the fable world show characteristic features of an animal in man, and in primitive cultures masks give magic qualities to man.

Comparison is based on findings of similarities. In psychosis it becomes identification due to the loss of  "as-if" quality. Identification corresponds with identity so related things become identical and similar things equal. The inanimate environment achieves characteristics of the living inner world. Electric voltage is equalized with nervous tension, the climatic atmosphere with the individuals own mood. The consequences for the person concerned are identified with the influences from the environment or a person. This leads to the magic world in which ones own experience is projected to the environment and the communication with it becomes alive. The resulting animation of objects and impressions is represented in the personification of objects and structures (moon-face, fairy-tale figures): serpentine figures become snakes, points become threatening eyes. Mental or instinctive influences are personified as demons.

As the Ego is not yet distinctly defined at the source of the psychic development (disturbance of the limits of self in schizophrenics) it consists of single elements. These, however, are identified as an independent whole. Single parts of the body, organs, psychic energies can be experienced as autonomous, as if it were a person of it's own. The tendency to incorporate one desires and inner contradictions as persons leads to the so-called "split" or "multiple" personality.  Single elements of the person can appear inside and outside the body as communication partners (e.g. hallucination of  commenting voices). The poor self-integration is exhibited on the one hand in the fragmentation of the person into singular parts and in an abnormal concentration on the person itself on the other hand.

Therefore in paintings of schizophrenics we can find the experience of an extracorporal sense of self (Heautoscopia), of doubles (shadows, mirror) as well as frequent self-portraits in the different frames of mind. In the projection of the Ego which is subjected to constant alterations because of instability and distorted self-perception, the consistency or reality of the own person is permanently monitored in the mirror. Thus the person concerned sees himself also as multiple persons in the mirror (concretization of single changes which are identified with one general alteration to another person). The individual constantly watches to see if facial expressions such as a grimace, or if his bizarre or affected posture still belong to him or her. The pathological self-regard is part of the anxiety of loss of oneself, an anxiety which can increase to paranoia.

The egocentric perception of the world measures the impact of the environment with the degree of its concern.  A schizophrenic who is afraid, perceives his environment as dangerous. As the order of the impression reflects in that of the expression it can result in shifting the relationship of size and in the so called nullification of consistency in size and  perspectives. Subjective overestimations and omissions can be detected in schizophrenic art via a distorted order of size elements in the pictures.

Ambivalence is one of the main characteristics of the schizophrenic patient. In common language this extreme contradiction, where opposites do not exclude each other, is metaphorically called "schizophrenic". We can only experience the whole world by putting together parts that are similar, and by dividing those that are different. We can only think in contrasts, in polar extremes. Where there is shadow, there must be sun. A hole is filled by a vacuum. Both can be seen as a whole as well as something that is separate and opposite. While the "normal" understanding "splits" one (hole) from the other (vacuum) the schizophrenic equalizes it by accepting it as the same. This leads to the picture puzzle and the ambiguities.

The pictorial expression of schizophrenics often is compared with that of primitive cultures and of children, as the psychotic inroad into basic structures of our patterns of experience and behavior gives us insight in the biogenesis of our own psyche. By the appearance of  movement patterns and of automatisms learned in developmental history, the pictures of schizophrenics show involuntary automated traces of movements and scribbles as well as stereotypes. It is striking to see the similarity between paintings of schizophrenic patients and those of children.  People are represented as cephalopods and radiographic or transparent as well as folded, pictures which are described as a typical developmental step in graphic design. In comparison with children and primitive cultures as well as with artists who dealt with the description of the archaic world one must not fail to see that the normal imperfection of a healthy developmental stage can not be identified with the disintegration of a matured psychic structure. Thus the schizophrenic thinking is only relatively suitable as a model for the understanding of "primitive" thinking.

The psychiatrist Prinzhorn (1922) studied pictures of  psychotic patients which he did not classify as unique results of sick minds that perceived and represented  the world distorted, but which he took seriously and he came to the conclusion:


"Wherever you apply comparative psychology the most reliable schizophrenic symptom disintegrates in elements, which occur frequently in other psychic connections - thus also with us."

The schizophrenic can give us insight into the basic characteristics of our life, because as a result of his illness he identifies the collective consciousness with his own. This is also what artists who dealt with the superficially viewed "crazy" style of these people have learned.



Anton Blitzstein (born 1959)

MY LIFE

"It was 1981 when I was about to open a little shop at Tabor Street with a friend of mine. We traded with diamonds and gold jewelry when we fought with a foreign Mafia-organization because we had refused to deliver part of our income. My friend Franz was murdered by a shot to the head, and I was left with a stab-wound in my abdomen.

Half an hour I lay in my own blood, fighting for my life, until the rescue service came and took me to the hospital.  In an emergency operation they saved me, but later I had to suffer five more operations before I could be discharged almost cured.  Not only my abdomen was scarred since that incident - my psyche was also impaired so that I required  permanent psychiatric therapy.

Without a job, outlawed by the community, I fled into my own reality. I enjoyed being occupied with extraterrestrial forms of life.

One full moon evening in spring I had real contact with extraterrestrial life for the first time.  Because of the good weather I made an excursion when I saw at a distance in a clearing, strange unusually moving creatures. They had a bodies of light, almost heart-shaped heads, a proboscis, four ears,  pawlike hands and a tail, which reminded me of a cow, therefore I called them later mooncalves.  

Curious as I was, I stealthily moved closer and saw that they apparently performed dancing experiments with light. The strange noise around this event was like a kind of  space music which obviously was produced by their movement and which I liked very much. The mooncalves left a very friendly and pleasant impression with me.

Some months later I had a similar strange encounter. When I tried to talk about it with friends, I was advised to go back to psychiatry. There I told different psychiatrists about my experience but the doctors diagnosed it as a kind of hallucination and prescribed psychochemicals.  Because of the strong side effects I did not feel well under therapy and I was able to convince the doctors to discontinue the medication.

Since then I learned to live with the mooncalves and became very fond of them. I know that mentally they are far more developed than humans, and that they come down to earth only to help us and to give us their love. Since that time I could help other people who were in a critical stage by telling them stories about the mooncalves so that they found a way out of an apparently hopeless situation and rediscovered their personal value in life. Unfortunately, I never had a camera with me when I met the mooncalves, so that I could only describe their appearance in paintings."  

Anton Blizstein
 

PETER KAPELLER,  THE ARTIST:

"I live in a 300 square feet apartment, which I also use as my studio. I have a rough table, a  drawing table. On the table there are a working lamp, a paper sheet and my utensils. My room is light. Sometimes I am filled with sadness, melancholy or other feelings, which result from the bitterness and the experience, from wounds and the longing for better times.

Then I take my tools and intuitively work on a sheet of paper which for me is more than a sheet of paper.  I work sometimes sensually, then again remembering, forgetting ... all that with a sheet of paper. I draw from morning until night. I have no other value. I draw everything freehand, without screen and aids."


Explanations to the picture: "la lettre à Véronique" (the letter for Veronica) 50 x 70 cm. signed and dated: "Peter Kapeller 1999".

The materials were drawing ink, brush and radiograph.  It is a pen and ink- as well as a brush-drawing.  The viewer sees part of the St Stephan´s Cathedral and the surrounding houses from a birds-eye view. In addition parts of the bridge of the city-railroad and the Danube canal are seen looking through the front of a house - part of this front reflects in the Danube canal. The graphic part: darkly drawn texture. Woman at a soiree. All this gives enough room for speculations: Is he or she, in a letter to Véronique, describing a visit to Vienna and Prague (there is an abstract description of the "dancing house" in Prague)? Did he or she meet somebody?  What kind of relationship can be assumed between Véronique and the author of the letter? Does the letter have the only purpose to describe the last time or does it express deeper wishes as well? Did they spend this time together? Did they see the city together? Or do they want to meet there again?


Explanations to the picture: "Drawn yesterday"

        Edgar Degas - "Woman in a bath-tub"
        Jean Tinquely - "Hong Kong"
        Claude Monet - "Water lilies"
        Drahomir Josef Ruzicka - "Pennsylvania Station"

The image is entitled „Drawn yesterday“, 59.9 x 70 cm, signed and dated 'Peter Kapeller 1999'.  Materials are watercolors and liquid inks (radiograph pen).  It is a montage utilizing brush and ink images, Photographs of E. Degas' "Woman in the bath-tub", J. Tinquelys "Hong Kong", D.J.Ruzickas "Pennsylvania Station", and photos of animals.

These sources were taken to create this image and then altered. In this picture I wanted to show a piece of life but also the threat, like the fire of the building. The drawing is in black and white because I had seen the movie "The third man" which inspired me visually. I looked through artistic photographs of the years from 1910 to 1950, pictorialism of D.J.Ruzicka or Man Ray. My drawing was intended to be an homage to those photographers who were artists as well. My aim was to put all this together into a picture and in its middle the machine, Jean Tinquely's "Hong Kong", a contribution of the artist which symbolizes the uselessness of what people do with this machine.

I wanted to question my picture, and myself even my life. My question was: Are we not able to mount, manipulate, irritate, or show a visual false yesterday as a fraud to overstimulated people?  Does it not happen again and again in media, on television and photos?

This should be represented in the montage of my work. I did it with a certain sadness, as I very seldom feel happiness. I draw in black, but I also show the beauty of the woman in this picture. In addition to that I wanted to produce "drawn cinema for the eyes". It can also be understood in a completely different context.  Tomorrow I will say something else about the picture named "Drawn yesterday".

Peter Kapeller


Poldinger
 

 





PSYCHE & ART
Chapter 5

Which Psychodynamic Motives Form The Basis Of Art And Creativity?

      
Which Psychotropic Factors Are Associated With Art, And Which Psychology Is Creativity Based Upon?

By Walter Poldinger – translated by Heinz A. Pieniak

Physician and poet Arthur Schnitzler  examined the phenomena of love and death and play because he was especially interested with the problems of suicide, love and death.  With figures like Anatol or the “Sweet Girl” he lent his name to an entire epoch.  In his works he attempted to expose deceit and hypocrisy of the time.  As an example, in his novel, “Lieutenant Gustl” he mocked the hollowness and hypocrisy of the Code of Honor of Officers, with the result that he had to defend himself in military court.

On his 60th birthday, May 14, 1922, Schnitzler received the following letter from Sigmund Freud the founder of psychoanalysis:

  “I often have agonized over the question why in all these years I never made the attempt to get in contact with you or to have a conversation with you….  The answer to this question centers on a confession, which is very personal to me.  I think I avoided you because of my trepidation to consider myself as an impersonator.   It is not that I am easily inclined to identify myself with someone else, or that I wanted to disregard the difference in talent which separates me from you, it is rather that whenever I became engrossed in your beautiful creations, I believed to have found behind the poetic brilliance the very premises, interests and results which were familiar to me as my very own…..I therefore have the impression that you, due to your intuition – but actually as a result of your fine self-awareness – know all that which I have in arduous work discovered in other people”.  

In his letter, Freud testifies that Arthur Schnitzler through intuition demonstrated all which Freud himself had to discover through painstaking detail work and as a result of self-awareness.  The comparison of these two historic personalities shows clearly the psychotropic effect of art.  Often literature and the science of the soul have the same sources.

The ancient Greek poets already knew that art has a certain liberating effect to the inner life of those who turn to it.  From them Sigmund Freud inferred the concept of catharsis in connection with free association.  

After he initially established that it is a relief for people when they could talk about their problems, he discovered when he encouraged them to tell whatever had come to their minds, especially in connection with dreams they have had, his patients were able to recall past events.  He called this path to the unconscious of his patients “psychoanalysis” and with that he continued a tradition already sketched out by Friedrich Nietzsche termed “the philosophy of looking around the corner”.  

Friedrich Nietzsche described by the following words that this is also a means by which unpleasant, suppressed relationships can again become conscious:

 “My memory says, this is what I have done.  My pride says I could not have done it.  In the end my pride wins out”.  

From this we see that a philosopher and a physician walked along the same path to raise into consciousness the suppressed relationships from the unconscious to analyze them.

Fine Arts contribute greatly to the exploration of the causes of psychological disturbance.  This is illustrated by the example of melancholy.  The Old Testament describes that with his harp playing, David cured King Saul of his deep depression.  This may be the first literary account of music therapy, which especially under the influence of Carl Orff reached great significance during recent decades.  

In music therapy, plucking stringed instruments and percussion instruments can be utilized by all.  For instance, people who are not yet capable to converse with others, can make contact with each other by the beating of certain rhythms.  Through the application of music therapy to groups, the dynamic effect of the group is used as reinforcement.  In music therapy, emotions may be released, but also certain moods can be created or acted out.  With that above all, the sociotherapeutic element of the joint music making assumes special significance.  

In literature one finds many testimonials of the suffering of depression.  Hermann Hesse, who himself suffered from depression, especially well relates to the depressive syndrome in his “Peter Camenzind”:

“The first weeks were alright and quiet but then the old sadness gradually returned, it stayed for days and weeks on end and did not disappear even during work.  He who has never felt melancholy himself does not understand it.  How should I describe it?  I had the feeling of dreadful loneliness.   Between others and me, the life in the city, the places, the houses and streets there was always a wide chasm.  When a great tragedy happened, or important news was reported in the newspapers, it did not concern me.  Holidays were celebrated, the dead were buried, markets were held, and concerts were performed; what is the point?  I hurried outside, I frequented the woods, the hills and country roads and surrounding me lay the meadows, the trees and the fields staying quietly surrendered to grief; they looked at me silently and imploringly having the yearning to tell me something, to approach me, to greet me.  They, however, lay there and could not say anything and I understood their suffering and joined in their agony because I could not liberate them”.  

Franz Grillparzer who entrusted his own recurring depression to his diary described individual components of the depressive syndrome as an example. He describes his loss of interest as follows:

 “My heart has become indifferent.    I am not interested in anyone, in no pleasure, in no thought and no books.  I may have possibly tried to end it all, if under the circumstances I would have not thought of it as cowardly.  So much, however, is certain that when all my efforts to calm myself and to keep active remain fruitless, a more miserable existence can hardly be imagined!”

In the same diary he describes one of the most tormenting symptoms of depression namely the compulsion to brood:

“My condition is awful.  Any thought of poetry has vanished, even reading fails to interest me.  I do not care to think.  Like being attacked by dogs, tormenting thoughts do not allow me to know which way to turn”.

An important symptom of depressiveness is also the isolation, and from there the resulting loneliness.  From the fine arts one may look at examples.  In the painting “Loneliness” by Edvard Munch.  He expresses clearly that even as a couple one can be lonely.  In this connection one is reminded of the desolation a partner can experience in an apparently working marriage, especially when the relationship is mainly limited to sexuality.  Strindberg in his work provided rather memorable examples of this when one thinks of the descriptions in his autobiography or works like “Fraeulein Julie” (Miss Julie).

Visual artists especially tried not only to portray the psychological state of depressiveness but also the typical facial expressions and posture of the depressed.  In the portrayal “Saturn” by Hans Baldung Grien one discerns clearly the “Veraguth’sche Falte (Fold)”, the strongly pronounced nasolabilial folds and the down turned corners of the mouth.

Entirely different relationships exist between suicidal tendencies and art.  When Goethe authored “Werther” which triggered a suicide epidemic, he later told Eckermann:

“This is none of my concern.  I got rid of my problems.  What the others do does not interest me.”

Goethe’s expression brought him much criticism, and was with embarrassment, yet politely excused by his admirers with “Olympic calmness” (Sperber).  At least since the time of “Werther” one knows that on one hand suicide can have an infectious effect and that on the other hand it is possible for creative people to reduce their potential for suicide through activity.  In the process, corresponding investigations have recognized that artists who ended their lives by suicide, with few exceptions seldom or never expressed ideation of suicide in their works.  

One artist, who died of natural causes at a great age, is Alfred Kubin, who frequently portrayed the theme of suicide and death.  Besides his graphic art and paintings, Kubin wrote a fantastic novel with the title “Die Andere Seite” (The Other Side).  In it he describes a regime of terror in a far away empire, an activity that obviously freed him from a psychological crisis with thoughts of suicide.

As an example of an artist who committed suicide, one needs to mention Ernst Ludwig Kirchner, who in 1938 shot himself in front of his house in Davos.  Kirchner is an example of a painter who committed suicide but in his art scarcely considered this theme.  Only on one occasion after the suicide of the daughter of a friend, did he fashion a painting with this theme in which he depicted the female suicide.  

During the second half of the 19th century the first psychiatric clinics were set up as independent hospitals. Their main function was to protect the patients from aggression toward themselves and others.  Therapeutic means were modest and consisted mainly of administering hypnotics as sedatives.  The consequence of this was that the patients lead monotonous lives, which contributed to further distortions of their personalities.  It therefore was progress, when at the end of the 19th century work therapy was introduced in the psychiatric clinics.  The patients were occupied with simple tasks in the kitchen, the garden and farming mostly within the clinic.

Among the patients of the psychiatric clinic at the University Bern – Waldau, Adolf Woelfli, a schizophrenic farm hand from the Berner Oberland became famous as an artist.  The psychiatrist Morgenthaler later published the book “Ein Geisteskranker als Kuenstler, Adolf Woelfli” 1921. (A Mentally Ill Person As An Artist) which first received much attention among psychiatrists and later among artists. This work was somewhat overshadowed In its significance by the work of the Heidelberg psychiatrist Hans Prinzhorn “Bildnerei der Geisteskranken” (Creations Of The Mentally Ill) which was published in 1922, one year later.  

Prinzhorns’ book, which presented various illustrations, some in color, caused even more sensation, foremost in the circles of artists.  It probably influenced the modern art in an essential way.  These paintings gained notorious fame in an exhibition during the “Third Reich”, when they had to be shown side by side with pictures by modern artists under the title “Entartete Kunst” (Degenerate Art).  In this context modern art from that time was to be deplored and equated with that of the mentally ill.

In the meantime, 100 years after the birth of Hans Prinzhorn, work therapy evolved into occupational therapy and further into formative therapy especially in the form of therapy of painting  (Maltherapie).  Today painting, modeling, sculpturing and carving as form of treatment is known as “Creative Therapies” (“Art Therapy”).

A special problem which can be followed far back to the beginning of mankind, is the circumstance that ill people were held to be exceptional.  For example, the Italian criminal Anthropologist Cesare Lombroso provided a direct relationship between artistic creativity and mental disease.  He described his observations and reflections in his book  “Genie und Irrsinn” 1864 (Genius and Insanity), which became famous.  Among scholars this book met with great approval, but also set off intense discussions.  From these systematic instructions for creativity the previously mentioned art therapy or creative therapies evolved.  Psychoanalysis has also fully accepted artistic creativity.  As an example the psychoanalyst Wilhelm Steckel from Vienna coined the phrase: “It is true that all artists are neurotics.”  This does not mean however, that all neurotics are artists”.  In more recent times two psychiatrists, the Swiss Alfred Bader and Viennese Leo Navratil were preoccupied with these relationships.  In the process it became clear that the creative characteristics, which Navratil assigned to schizophrenic art, are actually creative characteristics of artistic creativity in general.

These are:
1. The need for expression with the objective of physiognomy.
2. The tendency for order with the objective of formalization.
3. The need for symbolism with the objective to symbolize.

The Swiss depth psychologist (psychoanalyst) Carl Gustav Jung paid special attention to pictures of neurotics and attempted to interpret them as if they were the neurotic’s dreams. It was these pictures, which especially set him on the track of primeval images in the human unconscious and the idea of the collective unconscious.  He called those primeval images archetypes, because the same primeval images are found in a variety of cultures.  His students, who were especially preoccupied with those pictures could later show, that there are actually pictures i.e. primeval images which accompany the development of a human being during the pathological as well as the normal stages of development.  With this it became clear that close relationships exist between psychological frailness and the loosening of the structure of thought and creativity.  

Today these studies are continued and treated interdisciplinary, predominantly by the “Gesellschaft fuer Psychopathologie des Ausdrucks” (Society for the Psychopathology of Expression), founded by Ottokar G. Wittgenstein.  On Monte Verita in Ascona the “Internationale Gesellschaft fur Kunst, Gestaltung und Therapie” (International Society for Art, Creativity and Therapy) was also founded.

At present one experiences not only increasing interest in the creativity of psychologically ill people but ever more healthy people try to expand their spare time to mainly occupy themselves with creative activities.  Corresponding to this need more and more accessories are made available for creative leisure time activities.  

The “Handbook of Psychology” (1976) defines creativity as follows:  “The ability to see new relationships, generate unusual ideas and imaginations and to deviate from the usual thought pattern”.

A unified Theory of Creativity does not yet exist.  In the meantime, the psychoanalytically oriented theories take a special place.  As only one example the Sublimation Theory of Sigmund Freud should be mentioned.  By reducing it to a simple common denominator it states that cultures emerge by the suppression and sublimation of the libido i.e. sexuality.  

Creativity theories addressing constitutional typology, like the ones by E. Kretschmer, deal with the difference between Cyclothymia and Schizothymia.  C.G. Jung theories deal with differences between extroversion and introversion and finally H. Sheldon with the differences between Visceratony and Cerebrotony.

According to Kretschmer one can differentiate as follows: The cyclothymic artist has phases of exceptional creativity until old age (for example: Goethe).  The schizothymic artist, in comparison has especially in his early years an enormous creativity drive, which then in time may dry up (For example: Hoelderlin).

In order to answer the question what the special attention to ones own personality may have to do with creativity, it is noticed that a particular type of self contemplation and a concentration onto ones own emotional life is probably the prerequisite to be able to express certain contents and connections.   From this point of view one needs to refer to those creativity theories, which show a relationship between the manic-depressive sphere and creativity (for instance Ehrenzweig).  These theories assume that during the depressive phase because of the compulsion to brood, certain problems are thought through which then receive a special emotional content due to the disturbed thinking process.

 A typical example of this is the romantic problem of “Eros and Thanatos” which again is closely connected with problem of suicidal inclination.  Here one is noticing again “Leiden des Jungen Werther” (The sufferings of the young Werther) by Goethe and its consequences.  In the hypomanic after phase i.e. during the manic high new associations of ideas are then converted into action to create new works of art.  In the framework one needs to point to the close relationship between depression on one hand and narcissism on the other hand.  

According to the results of modern research of the brain, creativity is located especially in the non-dominant i.e. mostly in the right hemisphere.  The left hemisphere (the dominant hemisphere for right handed people) is processing information predominantly linearly, like a computer, while the right, non-dominant hemisphere does it rather simultaneously and pictorial.  Or, expressed more graphically:  The left or dominant hemisphere may be described in terms of “verbal, analytical, reductive, disassemble into parts, segmentary, rational, time conscious, and discontinuous”, and the right non-dominant hemisphere as non verbal, holistic, synthetic, spatial-visual, intuitive, time independent and diffuse.”

Although the work and activity therapies already resulted in an awakening and encouragement of creative abilities, a new direction developed which can be collectively called “Kreative Therapie (Creative Therapy)” or in English “Art Therapy”.  The basis of this endeavor is to inspire the patients to shape their lives anew innovatively and creatively by attempting to stimulate their creativity from the formative up to the artistic levels (depending on talent).  In addition it proved important to demonstrate to the patients that they have abilities, which lay dormant and of which they have no knowledge.

When one presents the patient with a piece of paper and colored pencils and says: “Please draw something” the answer is usually:  “I cannot do it, I have not drawn anything since I finished school”.  However, when it is explained to the patient that he or she should not reproduce or copy something but just doodle, one surprisingly often finds outlines which testify to a vivid imagination.  Such drawings are not only used to energize these abilities, but also for the psychotherapeutic appraisal of their content.  

Artistic forms, regardless of type, can be interpreted in accordance with free association during therapy by experienced psychotherapists in ways similar to what is done in analytical psychotherapy with dreams.  Naturally this presupposes much experience.  It can lead to considerable complications when a psychotherapeutically non-trained person may start with wild interpretations, possibly causing fear and panic in patients.

It is therefore that the application of artistic creation as therapeutic means should be practiced according to the following guidelines:

1. To work artistically can stimulate creativity.  The latter as well as the process of creating itself, can unfold a therapeutic and rehabilitating effect.

2. The creative formative process can become an important step of personal development beyond rehabilitation, especially for people with an artistic talent.  An example worth imitating is the “Haus der Kuenstler” (The house of artists) in the Landeskrankenhaus (Regional Hospital) for psychiatry and neurology in Klosterneuburg/Gugging in Lower Austria.  There a number of seriously ill patients were successfully brought to create mainly artwork, but also literary work.  Over time, due to their talents, they established themselves in the world of art.  With that it has become possible to provide the seriously ill a certain amount of independence, while a number of very gifted patients established themselves as artists with a promising future.

3. Art therapy can be utilized in the framework of psychotherapies.  Sigmund Freud already published some drawings of his patients to better demonstrate the content of their dreams.  Above all C. G. Jung and his student J. Jacobi regularly encouraged their patients to paint and to model with clay and plastic.  The meaning, which these articles expressed, was then in the course of the psychoanalysis used as a basis for associations similar to dreams.  Again it has to be pointed out that this type of creative therapy must allowed only to be performed by therapists who have a thorough psychological and psychotherapeutic training.

In conclusion, the objectives of creative therapy are summarized as follows:
The personal experience to create without direction and constraints.


The experience of being able to do something, without having had prior knowledge of this ability.


To experience the verbal feasibility for communication


To experience the amplification effect of groups in group therapies.


To create artistically with emotion, may prompt to plan the future life with creative expressions and with reference to emotionality.


The training of the mostly underdeveloped, non-dominant hemisphere to be able to plan in the future and to act more emotionally and with a holistic view.


To acquire compensatory strategies for (daily life’s) requirement for reason.

 

 


 



SCHIZOPHRENICS ARE ARTISTS

Leo Navratil Translated by Therese D. Barnette

 

In 1992 I published a short essay entitled “Schizophrenics are Artists” (Schizophrene sind Künstler”) (Navratil 1992a). At the time I did not even dare offering it to a professional journal. The article was subsequently printed in a Viennese art and literature journal.

In a written exchange during 1988 and 1989, Manfred Bleuler and I reflected on our ideas on this subject. He wrote to me, “I have no qualms with the aspects of neurophysiology in the teachings of schizophrenia. However, what is more important in the understanding of the individual schizophrenic is: schizophrenics are artists.”

In his introduction to the chapter on schizophrenia, in the “Handbook of Psychiatry and Mental Health” published in 1991, Bleuler wrote that even patients with severe schizophrenia, do not lose their inner life despite the split of important parts of the inner self. Rather, the inner life remains, as it exists in healthy individuals although it is frequently concealed. He wrote, “It has been demonstrated that the inner life remains rich, including artistic sensibilities and creative capabilities.” Bleuler then referred to my article quoting my conclusion, “that every schizophrenic is an artist (Bleuler 1991, Bd.1, S. 733)


ERNST HERBECK


Ernst Herbeck (Navratil 1994) was born 1920 in Stockerau. Schizophrenia manifested itself at age 20. Between 1940 and 1942 while hospitalized at the Psychiatric Clinic of the University of Vienna, he received Insulin shock and Cardiazolshock treatments. Again he was again hospitalized briefly in 1945 followed by permanent hospitalization in 1946 with his admission to the Lower Austrian State Hospital for Psychiatry and Neurology in Klosterneuburg-Gugging (“Niederösterreichisches Landeskrankenhaus für Psychiatrie und Neurologie Klosterneuburg-Gugging”).

Herbeck’s illness began with his belief that a maiden was hypnotizing him. He heard the maiden’s voice from any distance near or far and believed her to be in love with him. He felt constantly influenced by this creature; she commanded him to pursue actions against his will. Then corporal hallucinations set in. Herbeck sensed specific persons or snakes within his body. When agitated, he would slap his face or beat his head against the wall. Physically Herbeck suffered from a multiply corrected lip-jaw-palate-cleft. He spoke rarely and his speech was difficult to comprehend.

I spent the years from 1946 until 1986 as a staff psychiatrist in the Psychiatric Hospital in Gugging. So I started my training as a young physician in the same year in which Herbeck, by birth one year my senior, was hospitalized. He remained there from 1946 until his death in 1991. During the early sixties I made weekly rounds at the Haschhof, our hospital’s remote annex, where 30 male patients worked in agriculture. They resided in an old Art-Nouveau style villa. Among the residents was Ernst Herbeck who at that time had already been ill for 20 years and continually institutionalized for 15.

On a late summer morning in 1960 during one of my rounds at the Haschhof Ernest Herbeck’s first poem emerged. I invited Herbeck into the consultation room, placed a white postcard sized piece of cardboard in front of him (I frequently let patients draw on such cardboard), handed him my ballpoint pen and said, “please, Mr. Herbeck, write a short poem entitled ‘The Morning’.” Never before had I given a patient the directions to write a poem. Herbeck reflected briefly then wrote


Der Morgen


Im Herbst da reiht
der Feenwind
da sich im Schnee
die Mähnen treffen.
Amseln pfeiffen her im Wind und fressen.


The Morning

In autumn there ranges
the oppressive warm wind
where in the snow
manes touch one another.
Blackbirds shriek about in the wind and feed.


Upon reading these lines I recognized the schizophrenic speech disorder, yet simultaneously – their poetic nature.

Looking back, this event can be best explained as a transformation. Ernst Herbeck transformed himself. Not from a bear into a prince but from a patient into a poet. Romantic as it may sound, this actually happened, in that setting, in the harsh reality of 1960. For him, this transformation brought about long lasting, very real consequences.

From then on I had Herbeck join me in the consultation room when I came to the Haschhof. I would present him with a title and invite him to write a short poem. The specific scenario of our first such encounter was played out in its entirety during each meeting and the ritual remained over many years.

Herbeck read his poetry to audiences at the hospital and in the general public. Taking great pride in the applause received, he would rise and bow in recognition thereof. His poetry was published in magazines and in several books. It was also translated into other languages.

Herbeck experienced this success during his lifetime; he was very much aware of it. Scrupulously following his regimen with medications, Herbeck maintained his status as a hospital inpatient until his death in 1991. Even after thirty years he always needed an invitation to write a poem.

In 1982 he wrote:

Ich kann heute leider nicht,
weil mir sonst eher das Herz zerbricht.
Sag zum Schreiben lieber nein,
sonst ist alles allgemein.

I am unfortunately not able today,
my heart might otherwise shatter astray.
To writing I’d rather say no,
else everything is just so.


During the presentation of Ernst Herbeck’s posthumously published “Collected Texts 1960 – 1991” (Herbeck 1992) at the National Library of Austria, Ernst Jandel commented that the poet Herbeck “is entitled to his undisputed place in German poetry of the second half of this century.”


OSWALD TSCHIRTNER

Oswald Tschirtner was diagnosed with schizophrenia while in French captivity (Navratil 1994). In 1946 he was handed over to Austria at the Austrian border. He was then transferred to the Psychiatric Clinic at the University of Vienna where he was treated with Insulin shock treatments. At one of the treatments he asked, “why am I condemned to death? I am not the Führer. May I please return home to my beloved fatherland?” In 1956 Tschirtner was transferred from the University Clinic to our hospital. His transfer file simply stated: “completely wasted”.

Oswald Tschirtner’s mental disorder is, among other things, characterized by his inability to make decisions, to be decisive. However, it became apparent that Tschirtner, upon being asked to draw something always complied with the request. He would sit across from me at the desk. I would place a small piece of cardboard (to begin with size A6, later also A5), a pen, and India ink in front of him. Perhaps I might clean his glasses for him and encourage him to try out the pen. I then would give him a task such as, “please, draw a rabbit”. Whereupon Tschirtner would write on the drawing paper “a rabbit” and commence to draw.

This process repeated itself in the same manner innumerable times over the years; the only variance being my changing the theme. Pronounced stereotyping ruled Tschirtner’s behavior and his drawings. Surprising solutions were, however, also revealed. He consistently drew humans as extremely reduced, elongated stick figures, reminiscent of Giacometti’s sticklike figures (Navratil 1992b).

Tschirtner had drawn predominately in the stick-figure style for a number of years when one day I presented him with a pattern encouraging him to copy it. Suddenly, completely different results emerged from the drawings. Tschirtner worked longer on a given task and commented that the sample pattern facilitated drawing for him. As soon as I requested him to draw without a sample pattern he would immediately resume his stick-figure style.

In 1970 Tschirtner and our manic depressive artist Johann Hauser had a large exhibition at the Museum of the 20th Century in Vienna. During the opening ceremonies Tschirtner, elegantly dressed, sat in the front row with other guests. The museum director shook his hand thanking him. Tschirtner’s entire extended family was present.

Tschirtner participated in many subsequent exhibitions. At 78 he is one of the most renowned Gugginger artists. The same transformation took place for him as for Ernst Herbeck.



HAGEN RECK

Hagen Reck (Navratil 1994) was first treated as a psychiatric in-patient during the war while serving in the military. Later he began medical studies passing the pre-clinical exams; he was however, unable to complete his medical education.

He was engaged in anthroposophy (believing that with personal discipline and training, one may experience the spiritual world) and was an excellent violinist and pianist. He resided with his mother, a retired German classical secondary school professor. Now and then he spoke incoherently. He was reduced to a childlike state and occupied himself only with his “Märklin Bausteine” (a well-known set of children’s building bricks from Germany). These represented to him his own planetarium, his own world. He declared one could create anything with this set of bricks: flowers, snowballs, anatomical specimen and even - a son.

Due to schizophrenia Hagen Reck frequently spent time in our hospital beginning in 1995. He also wrote and drew upon request and appreciated my interest in his productions. ”. He once wrote “It is the task, in the task it lays, when the crayon flies across the paper”.

Hagen Reck once mentioned that he could write poetry in several languages: apart from German also in English and Latin.

Upon my request to write a poem wherein the three languages would be used, he wrote:

Oculus est in tempore nostro.
We have been always in quarrel.
Und sehen dabei immer dem Tempel.


The vision is in our time.
We have always been in quarrel.
Aware always of the divine.


When asked to differentiate between talent and genius, he stated, “talent is aptitude and genius is permission.” Friends of our artists, particularly those involved in literary activities, admired Reck’s intelligence and productivity. When encouraged to write poetry or read his works aloud, his heightened mood caused his face to radiate and gave his voice a firm ring.

Placing human beings like Hagen Reck in nursing homes is disgraceful. They need inner stimulation, the consistent relationship with a therapist and an artistically oriented environment.



JOHANN FISCHER

Johann Fischer (Navratil 1994) had already been hospitalized for twenty years when we admitted him to the Artists’ House only to fill an empty bed. He reportedly was a friendly patient, communicating his absurd delusions upon questioning. Otherwise he was only noticeable for certain ludicrous behaviors. At times one could see him walk backward on the asphalt road leading up the mountain. At other times he would lie flat on the street for brief periods. Otherwise Johann Fischer would sit among the other patients in the day room fitting well into the living arrangements.

One day without my suggestion, my secretary placed pencil and paper in front of Johann Fischer asking him if he would also like to draw something. When he noticed the other patients drawing, he tried – and became an artist. He was hugely successful, exhibiting and selling his work. This year he will be 79 and he is one of the most industrious of our sketchers. An early drawing represented Johann Fischer’s change: “My first and my second life, first as a farmer on the manure pile and now as an artist.”

He spoke of a golden telephone without a dial, which he had received from “his father’s god’s highest almightiness”. Through this he came to know his enemies’ machinations and been informed of his own possessions, of his inventions, as well as of his personal position in Austria and the world at large.

Johann Fischer’s case also illustrated how much the writing and drawing of schizophrenic patients - in which only we (therapists) recognize the art - depend on outside stimulation, on outside possibilities.



AUGUST WALLA

August Walla (Navratil 1994) was born in 1936, the only child of a 40-year-old mother. He never knew his father and was reared by his grandmother in the pea-patch garden. When Walla was six years old, just before he became of school age, his grandmother died in front of his eyes. Immediately thereafter he became of school age. Since the mother was under obligation to war service, the boy was largely left to his own devices and became psychotic. He spent over a year in a pediatric mental hospital and afterwards was placed in a reformatory. At the end of the war Walla’s mother was able to look after him.

He attended the school for challenged children in Klosterneuburg. He was never employed and was always in his mother’s company. Exceptional in their unkempt and slightly neglected appearance, they were an easily recognized twosome in Klosterneuburg when they slowly shambled across the town square.

After his sixteenth birthday, August Walla was hospitalized numerous times in our clinic. Currently he lives in the Artists’ House. Thus I have been able to gradually gain insight into the diversity of his productivity. Walla’s work encompasses various areas in which the individual can express himself artistically. I was drawn into his world of gods and demons through the inscriptions I found in his garden and via those I found in his writing and sketching notebooks. However, years passed before I understood his very systematically constructed mythical/magical world. An entire pandemonium represented the content and engine of his fantasy and art.

Even before the warm season began, August Walla and his mother lived in their tiny garden house located in the fertile plain of the Danube. August wandered aimlessly about the area carrying home items he had found in garbage dumps, piling them all up in his garden. This garden, with its large jumble of collectibles, among exuberantly growing weeds, presented an unusual sight. Walla’s garden owed its singular stamp (impression) to the many inscriptions and emblems on doors, walls, boards thrown about, tin and even on trees.

A large piece of cardboard placed on a stool under a bush bore the inscription “WELTENDEGOTT” (WORLDENDGOD) painted with a wide paintbrush. Upon a closer look one noticed that two previous inscriptions existed under the current one, both in different colors each face fully covering the cardboard.

The abundance of old, used items torn from their usual context often combined grotesquely with each other. Among the intrusive inscriptions and letters, symbols and words - all under the open sky among lush vegetation - August Walla and his mother gave the impression of originality.

August Walla writes in long hand and on the typewriter. He is a script-artist and a poet. He collects dictionaries and invents secret languages. He shapes new letters, names and symbols. He inscribes and paints his entire surroundings. He takes photographs, and tinkers. He leads public and private campaigns with the assistance of objects as well as with his own body. He is interested in music, collects lyrics and now and then writes music into his own texts.

Psychiatrists of the past would have seen nothing but psychopathology; the detached symptoms of schizophrenia in August Walla. I saw it as my responsibility to recognize his work as auto-therapy and to intrude in neither his fantasy world nor his activities. Schizophrenic art is to a high degree an inner monologue with farthest reaching independence of any addresses. Even so, I believe that schizophrenic art has an appellative and communicative character. I therefore also saw my mission to facilitate recognition of August Walla’s spiritual products as art. This led me to document and publish his works and to arrange an exhibition.

In 1973 I published an extensive report about Walla. It was illustrated with numerous photos of his garden and himself (Navratil 1973). My report also announced a monograph, which was published years later (Navratil 1988). Through the exhibition and the published activities August Walla has turned from an unpopular, scorned outsider and a psychiatric case, into a respected artist. He is transformed.



EDMUND MACH

Edmund Mach’s literary activities (Navratil 1994) began in 1965 during a hospitalization in the psychiatric clinic. Every morning he came to my office. Paper and ballpoint pen lay ready. I gave him a theme whereupon he began to write immediately. While writing he seldom hesitated, rarely pausing to reflect. He wrote down everything as it occurred to him, usually filling a page. Then he would read the text aloud.

Der Dichter

ist langsam beginnend
schreibend in seinen Zeilen verharrend
bis Ende kommend
das ist der Dichter


zu näheren Reimen muss
er sich mühen
um die Romantik zu berechnen
die nahe ist


Er berührt eindeutig
das Gedicht in Gedichtform
und eigen sind die Reime
die umspielen sein Gedicht


The Poet

slowly beginning
writing, persevering in his lines
until arriving
that is the poet

for specific rhymes he
must struggle
to calculate the romanticism
nearing

he doubtlessly touches
the poem in poetic form
original are the rhymes
playfully interweaving in his poem


Edmund Mach had never written previously. Since 1967 his poetry has been printed in books and magazines. In 1982 he was able to publish the volume “Buchstaben Florenz” (Characters Florence). He personally signed the publishing contract with his guardian’s consent.

Born in Vienna in 1929, after completion of the German classical secondary school education Edmund Mach began university studies, but did not complete them. At 28 he was admitted to a psychiatric hospital for the first time. He said that he lacked the courage for living; that recently everything appeared unreal to him as if it were a dream; that he was incapable of remembering all; and that lately much was confusing, his subconscious seemingly out of order. He said, “as far as logic is concerned, I barely handle A and B, resulting in an incorrect C.”

In a depressive mood Edmund Mach once commented to his mother, “I am not even deserving of my meals.” The mother’s response was “you will again deserve them.” His answer to her comment was, “actually I have been dead for ten years already.”

Between 1957 and 1984 Edmund Mach was treated as an inpatient thirteen times in our institution; his hospitalizations usually lasting several months. Eventually he came to reside in the Artists’ House where he remained until his death. Like Ernst Herbeck, Edmund Mach was accepted into the Author’s Assembly of Graz. In 1996 his second book was published. Edmund Mach died at 67 during a trip in the United States. His obituary carried one of his poems:

Dort in der Ecke ist sein Grab
hier und da knistert es
Leute gehen vorbei
es ist wie neu
das kommt vom aufregenden Leben.


There in the corner lies his grave
rustling here and there
People passing by
It is like new
Due to his exciting life


CONCLUSIONS DRAWN FROM EXPERIENCES WITH CHRONIC SCHIZOPHRENIC ARTISTS

I was asked the following questions (Thomashoff 1998). “How does a patient’s recognition of his art affect him? Is this recognition helpful to his social integration? Or does the idealizing of him as an artist perhaps lead to the wish to prolong the specific creative process of the psychosis?” On this we refer to the artist Arnulf Rainer who voiced the opinion that psychotic creativity was erased by a treatment with current medications.

I shall try to answer these questions briefly and keeping in mind the preceding examples. When a patient transforms into an artist a new identity joins the patient’s identity, namely the artist’s identity. Being an artist does not lead to recovery in chronically ill patients; their indigence remains. In the favorable case a certain fusion of the two identities surfaces which one can also see as a new approval. In such cases I speak of a transformation, which can be perceived as the equivalent to recovery when agreeing with Winnicott’s opinion, namely that creativity has no lesser meaning in a human being’s life than health itself (Winnicott 1979).

In his remarkable text “Psychiatrie in Lebens- und Leidensgeschichten” (“Psychiatry in Case Histories of Life and Suffering”), Hans-Martin Zöller writes about the so-called “last third” of psychiatric illnesses which take an unfavorable course. This third he describes as: chronically intensifying, petrifying, sclerosing, increasingly symptomatic, a consistent, irreversible worsening of the illness. Social descent and often lasting hospitalization are unavoidable despite all of the social-psychiatric agencies. “No path can circumvent it: significant psychiatric illnesses are destructive. They are more powerful than all of our medications; and they will always remain thus” (Zöllner 1997).

The artists from Gugging whom I introduced clearly fit in this unfavorable group of patients (Navratil 1998a). For them, therapeutic possibilities had been exhausted. One became resigned to their illness.

The entirely new social integration of our artists revealed itself in many significant and insignificant ways: the sketchers/painters were able to show their work and were admired as the works’ creators; the poets were able to autograph their books; they were able to read their texts publicly and receive applause. The patients received honoraria enabling them to make purchases, go on excursions and take trips. Most importantly, however, was the recognition bestowed on them at first by their therapist, then also by the public, significantly improving their self-esteem.

The use of modern medication in therapy has proven that the patients’ artistic creativity are not erased by it. The influence of medication on the patients’ creativity is, however, a question of appropriate dosage (Navratil 1998a).

Until the end of the 18th century physicians had the moral right to refuse treating mental illnesses, since they are often incurable (Ackerknecht 1957). The incurable were accommodated in prisons, poorhouses and other institutions. Today’s psychiatrists appear to reclaim this right. They rid themselves of the chronic long-term patients. The scarcely noticed ones who frequently become the “forgotten cases” of the psychiatric hospitals. While these hospitals reduced their bed count renaming themselves “neurology clinics”, the modern ghettos of our society resulted in “old age asylums”.

As in 1998 to my Swiss colleagues (Navratil 1998b) I will not cease to appeal not to give up the chronic psychiatric patients as hopeless textbook cases; not to place them in nursing homes where they would simply be medicated without psychotherapeutic care or ongoing research. In addition I express the hope that the theme “Psychiatry and Art” be incorporated in psychiatric lectures and textbooks to at least familiarize students with a few patients who have transformed into artists in the midst of their illness.