Transcultural perspective on psychiatric art and creativity and its consequences for psychiatry.

Transcultural perspective on psychiatric art and creativity and its consequences for psychiatry

Hans-Otto Thomashoff

[otros artículos] [27/2/2002]



A long tradition in psychiatry postulated an inborn human drive for art-creation leading to a specific style in the art of psychiatric patients, especially those suffering from a schizophrenia. Prinzhorn and Navratil are to be named in this context, but also the academic art agreed to this theoretical postulate, which was never actually proven, though systematic attempts to define a schizophrenic style have been made on the descriptive level, e. g. by Navratil and in more detail by Rennert .

But how to prove or falsify these theoretical assumptions? If there is a specific schizophrenic style, it needs to be to some extent independent of the cultural surrounding. So what we need to answer this question is an intercultural comparison of psychiatric art from different cultural backgrounds, which is the basic idea behind the concept of comparing African and European psychiatric art, as is done in this exhibition. Are there parallels in the patients´ pictures crossing the borders of these two highly different cultures and if so, what are they? And are there on the other hand also culturally specific influences defining the human being inevitably as a member of the culture he or she was raised in?

There indeed seem to be some fundamentals invariably present in the art of all humans suffering from a psychotic experience, which I want to describe and draw conclusions from further down. First I want to address the cultural surrounding as an enormously important factor in the perception of and in the behaviour towards the symptomatic appearance of psychotic episodes. During the Jubilee Congress in Paris I headed a symposium in which a colleague from the Ivory Coast described how in her culture traditionally schizophrenics are given the role of fetish dancers. They are not considered ill, bit instead fulfil a culturally determined role, which they are respected and paid for by the society. Coming from a Western European cultural background and a psychiatric training within myself this was indeed a surprise. The surprise broadened in the same symposium when another colleague, this time from the United States described how she was successfully opening up a clinic for the treatment of sexual addiction. Did such a diagnose exist in a city like Paris? And even more so, would it exist in a society like those in traditional Ivory Coast?

I was amazed to face the fact that all we define and learn in our profession is highly culturally determined and our search for clear guidelines and truths may often be attempts to cope with our own insecurity in the face of the fears linked to states of minds that differ from our own experiences. But these differences also provide us with an enormous potential for the promotion of the destigmatisation of psychiatric conditions.

Of equal importance I feel is the necessity to understand the needs of a person seeking our help. If we understand what is happening inside him or her, our fear is reduced and we gain the freedom to act according to his needs. This is where the perception of art as a language of the mind comes in.

I now want to go back to take a deeper look at some pictures of the Hamburg exhibition, which I think, actually do give us an idea of a dynamic principle influencing art according to the state of mind in a schizophrenic condition and which might be at least to some extent ubiquitary, which means that we should be able to find them in the African as well as in the European art of this exhibition.

If we take a closer look at our current knowledge of what happens inside a person experiencing a schizophrenic episode, it is the disintegration of thinking and an enormous, existential anxiety which seem to dominate the process. Like in a vicious circle the disintegration causes fear which in turn further enhances the disintegration. In the pictures of Jana Tumangelov from Bulgaria (48) and Peter Reischel from Austria (28-31), we can see how the regular forms of the persons painted start to lose their structure. They seem to melt, the proportions of their details are vanishing and the associated fear becomes tangible. Though from a completely different cultural background we can see the same phenomenon in the drawing of Peju Ilumoka from Nigeria (9). Parallel to the similarity in symptoms also the artistic expression shows comparable if not identical features no matter which cultural background we focus on.

But what happens next? Let us go further to a comparison of two pictures from the same artist. Anton Blitzstein from Austria (36-39) painted them at different times and in different states of mind. The first also shows intense signs of disintegration with the structures of the face shown merely recognisable (36). The second and third picture, which were painted about two years later in contrast consist of stable forms, in which the artist, as he describes himself, shows the so called “mooncalves” (37-38). These are creatures visiting him regularly during the times of full-moon, and he claims, that unfortunately he never has a camera with him which is why he has to paint them instead of taking a photograph. He also says that psychiatrists never believe him, which means that they obviously are crazy. Psychiatrists tend to see this situation the other way around. But what has happened? If we look at the formal style of the two paintings, we realise that the form in the later picture has come back to normal, has completely stabilised as has the psychic wellbeing of the painter. The delusion of these yellow creatures visiting him and only him has made it possible for him to find an explanation for these strange experiences of panic and disintegration he has had in the past. This explanation reduces the fear and hence stabilises his state of mind in turn also reducing the disintegration. The vicious circle has stopped. The delusion has helped the patient to reduce the severity of his illness, it worked as a defence against it. How often in psychiatry have we encountered a delusion to be resistant to therapy? The clue to this, I think, is the fact that delusions are not a core symptom in themselves, but instead they are a defence-mechanism against psychotic fears. This means that the way to get rid of delusions has to be to reduce the fear and through this make the delusions superfluous.

Certainly this is not always possible, but Benedetti for example has proven that this can be a guideline for a therapeutic work with psychotic patients. He lets the patient draw a picture, copies it himself, in this way joining the patient in his or her world and inside this world, where the patient now experiences not to be alone, questions the necessity of the delusion.

Also in the drawings of Peju Ilumoka (10-11) we can see how the later pictures find back to formal stability with their contents fixated on the almighty power and presence of a god, who seems to represent the explanation for and the protection against what he experienced during his psychosis.

Unfortunately the attempt to stop or alter a schizophrenic process through defence-mechanisms on the side of the patient or through the various therapeutic approaches on the side of the psychiatrist or psychotherapist not always proves successful. Often disintegration cannot be stopped and the result is a reduced level of perceiving and coping with the surrounding world.

Also here we can observe parallels in the artistic expression. Many of the “classic” pictures of psychiatric art consist of monotonous stylistic features being fascinating for their being different and through this finding new solutions for the pictorial representation of everyday subjects. Navratil listed some of the typical stylistic characteristics of such a schizophrenic style, and Rennert expanded this list in more detail. And indeed if we look at the pictures of for example Claudio Uliveri (44), who sticks to drawing pyramids covering the whole canvas in various colours or if we look at the ornamental style the writing of Anton Müllerh (22-23), which surrounds the topic of his pictures to describe their contents, we find exactly these characteristics. Again similar features are present in pictures from the African section of the exhibition, e. g. in the drawing of the anonymous artist from Morocco (16) or in the persisting use of bottles as a protection for his pictures in the style of Simon Soha from Benin (1-2). They can be understood as a parallel to the limited though in some way newly reconstructed view of the surrounding world that determines the thinking of chronically schizophrenic patients. It is a result of the brains need to construct a perception of the outer reality, even in this case after a destruction of this perception in a limited form of reconstruction. As creativity in general consists of the reconstruction of previously perceived material in the brain, a deconstruction of the existing structures implies a need for a reconstruction and in this way a potentially creative process. This explains why Navratil and others speak of a creative power of the schizophrenic process and why Horrobin links schizophrenia to the sophisticated level of the functioning of the human brain.

If we now place these observations into an overall model of what is happening in a schizophrenic process and how this is presented in art, we get to the following concept:

Disintegration of the thinking processes and a consecutive existential anxiety enhance each other leading to an overwhelming panic paralleled by dissolving forms in the pictorial expression. A subjective explanation helps reducing the fear and hence breaking the vicious circle of the process. What the outside world perceives as a delusion determines the contents of the thinking and the art produced, though due to the subjective relief stylistically the forms reintegrate to normal. Just if the defence of the delusion fails due to a progression of the pathological process the result is a limited interaction with the outside world as well as a limited, but often individually characteristic rather monotonous variety in artistic expression.

These likely fundamentals about the psychology of expression allow us to draw conclusions linked to our knowledge in psychopathology and in the function of the brain in general.

It is rather likely that the formal variation of the pictorial expression in this process in its culturally independent aspects are due to chemical processes mainly on the level of the synapses, the location of the basic pathology of schizophrenia, as it is to a large extent similar
in human beings from any cultural background, while the contents of the art is highly determined by the internalised subjective experiences including the cultural background of the individual, which may mainly be stored in representations on the level of the structural proteins of the brain. Though both levels highly and continuously interact, the first is mainly a domain of pharmacotherapy, and the second mainly of psychotherapy, though both levels continuously interact which is why both levels can be influenced both ways:

pharmacotherapy => synapses => protein

psychotherapy => protein => synapses

But if this is correct, how then can we understand that in some psychoses psychotherapeutic work has been successful? I conclude that not all psychoses are due to schizophrenia, but that instead psychosis is simply a severe symptom found in severe brain illness as in schizophrenia but also found in extreme psychodynamic crisis leading to what best might be called a psychodynamic psychosis. In this case it can be explained why some psychoses can be cured through psychotherapy and others cannot and on the contrary, why some psychoses are well treatable through pharmacotherapy and others are not. It also explains why some psychoses are progressing into a deconstruction of the thinking-processes, likely mainly those with schizophrenia or another organic cause, with the characteristic features stylistic in their paintings described above.

I am optimistic that the revolutionary advances in brain imaging will allow a proof of these assumptions in the not too distant future.

What kind of therapy for psychiatric conditions will be the result?

We live in a postmodern society with a strong deconstructivist tendency leading to an abandonment of ideologies, which in the last century not only in politics have caused so much suffering. For therapy the only criterion for it being right or wrong is the simple question, if it works. If it is valid it is valuable, if not there is no reason to stick to it. The dimension to evaluate this is the subjective wellbeing of the patient and of his surrounding. But how to get there? What kind of therapy is the conclusion of these assumptions? To me it seems likely, that we have to arrive at a biologically based form of therapy which is constructivist and psychodynamic in its nature and pragmatic in its techniques. Where biological psychiatry can prove that pharmacotherapy is the treatment of choice, this should be applied. As mentioned before this may mainly be on the level of synaptic disturbances. For changes on the level of the stored information in proteins a psychotherapy reconstructing former emotional structures by new relationship experience has to be the goal with the use of the preferred language of the patient, be it verbal, art, music or physical. The patients perception of himself and of the outer world is to be modified by liberating him from traumatic earlier relationship experiences. This perception as well as the methods for its change highly depend on the influence by the cultural surrounding, which leads us to the need to be able to question any diagnostic qualification leading to a potential stigmatisation of a person suffering as well as to tolerate any therapeutic approach proving valid within the concepts of a society.

In the example of the current exhibition we face very different concepts of psychiatric illness and wellbeing, which was the main reason for me to chose this comparison. For me it implies the chance to see contrasting opinions and concepts and to understand them as a basis for tolerance and learning. If a concept works for the individual within his society it proves useful. In an exchange of ideas every side can learn from the other and try out if the approaches of the other may be of help within one´s own concept. This does not mean an obedient or romantic acceptance of the ideas of the other for the own situation, neither the take-over of business-medicine in Africa nor the romantic use of traditional healing in Western societies, but to tolerate them and learn from them, while a careful evaluation of a concept in a different surrounding is needed.