Abstract
Objectives:
While mental illness has long been associated with states of heightened creativity, the intersection between psychiatry and art warrants further exploration. This paper seeks to examine some fundamental concerns common to both disciplines, highlighting the therapeutic potential of visual art within psychiatric practice.
Conclusions:
Psychiatry and art are both concerned with the visual embodiment of abstract internal states, compelling us to deconstruct surface appearances in the pursuit of deeper meaning. Both also offer a window into the manifold ways in which others perceive the world. In a practical sense, art has significant therapeutic value, providing patients and clinicians with novel ways of processing emotions and fostering self-expression and agency.
Art is a kind of innate drive that seizes a human being and makes him its instrument. The artist is not a person endowed with free will who seeks his own ends, but one who allows art to realize its purpose through him. As a human being he may have moods and a will and personal aims, but as an artist he is “man” in a higher sense — he is “collective man”— one who carries and shapes the unconscious, psychic forms of mankind.
1
In his exposition on the creative process, Jung eloquently captures the power of artistic expression to connect the viewer to the deepest facets of the human mind. For Jung, art enables us to transcend the confines of individual experience and tap into the wealth of instincts, fantasies and archetypes that constitute the collective unconscious. The potent function of the visual realm as a portal to the human psyche is perhaps most evident in Man and his Symbols (1964), which explores the symbolic language embedded in the works of an array of artists, ranging from Chagall and Goya to Dali. 2
As a psychiatry trainee, passionate amateur artist and scholar of the humanities, I am fascinated by the fertile intersection between art and the study of the human mind. Art can be broadly defined as the expression of human imagination through creative techniques. While a diverse range of creative activities such as music, literature and dance constitute branches of art, I will focus solely on visual art forms.
In the first section of this paper, I will explore the association between mental illness and heightened creativity. I will then highlight two primary concerns shared by art and psychiatry, namely the outward representation of abstract inner states and the complex nature of perception. Through this discussion, I will highlight the therapeutic value of art for both patients and clinicians. Ultimately, I hope to demonstrate the existence of a symbiotic relationship between these two domains, whereby each discipline can inform and enrich our understanding and appreciation of the other.
The historical association of creativity and mental illness
In his reflection on art, Jung likens the drive to create to a kind of spiritual possession, summoning the overwhelming intensity of a boufée delirante. This characterisation captures the long-held conflation of artistic genius with a kind of madness. 3 The trope of the ‘tortured artist’, exemplified by the Dutch painter Van Gogh, embodies the nexus between creative brilliance and inner torment. In the early 20th century, the concept of Outsider Art evolved to describe the creative products of those on the fringes of society, including artists living with mental illness. A defining moment in this movement was the 1922 publication of Prinzhorn’s Bildnerei der Geisteskranken (Artistry of the Mentally Ill), the first formal collection and analysis of artworks created by psychiatric inpatients. 4
In recent decades, the putative connection between creativity and mental illness has been widely discussed. Psychiatrist Dr Nancy Andreasen offers one explanation, noting that creative ideas probably occur as part of a potentially dangerous mental process, when associations in the brain are flying freely during unconscious mental states . . . such a process is very similar to that which occurs during psychotic states of mania, depression, or schizophrenia. 5
This notion is echoed by Sussman, who highlights neurobiological similarities between the creative mind and states of mental illness. 6
While mental illness is often associated with creative inspiration, certain psychiatric symptoms can limit an individual’s capacity for artistic expression. Reduced levels of motivation and energy combined with the pervasive anhedonia seen in severe depressive states can exert a stultifying effect on the creative mind. 7 Similarly, the loss of coherent thought form often seen in psychosis and mania can impede the realisation of creative impulses. The medications prescribed to treat mental illness can also inhibit creativity, with side effects such as sedation and affective blunting being a cause of concern to many patients. 8
The relationship between inner states and outward appearances
Psychiatry and visual art share a fundamental concern for the ways in which complex inner states can be represented. The creative process itself entails interpolation of layers of meaning into a visual form, such that the finished work comes to signify far more than the sum of its parts. In much the same way, the mental state examination that constitutes such a unique and central aspect of psychiatric assessment seeks to apprehend the emotional and cognitive processes of an individual as manifest in his or her external presentation.
The representation of complex inner states through visual forms is exemplified by the works of celebrated surrealist artist Frieda Kahlo. Kahlo’s striking self-portraits feature complex layers of visual symbolism to convey her personal struggles with mental and physical illness. In her 1945 self-portrait ‘Without Hope’ (Figure 1), Kahlo depicts herself lying immobilised in a four-poster bed, pinned beneath the wooden easel that was custom-designed to allow her to paint during prolonged periods of physical incapacitation. The focal point of this unsettling image, a large funnel overflowing with animal carcasses and entrails, evokes the visceral horror Kahlo experienced during her treatment. Kahlo’s inclusion of the easel in this portrait is significant as a self-reflexive comment on the role of art as a medium of expressing her internal world.
Kahlo, Frida (artist). (1945). ‘Without Hope’ [oil on canvas]. Collection of Dolores Olmedo, Mexico City, Mexico. Available from: http://totallyhistory.com/without-hope/ (Accessed 20 December 2019).
The function of art as a means of representing complex emotional states has given rise to its use as a therapeutic tool. While the formal use of art therapy dates back to the 1940s, it was not until the mid-20th century that its potential value in the treatment of patients with mental illness was recognised. 9 Contemporary art therapy remains rooted in the integral function of art-making as a means of expressing and processing emotions. As awareness of the physiological mechanisms associated with the creative process grows, specialised applications of this therapeutic modality continue to evolve. 10
The therapeutic potential of artistic expression for those living with mental illness is evident in the Cunningham Dax Collection. In the 1950s, psychiatrist Dr Eric Cunningham Dax played a key role in the introduction of an art therapy programme into psychiatric hospitals. With the closure of many psychiatric institutions in the 1980s, Dax salvaged thousands of the artworks that patients had created. Exhibitions of selected works at the Dax Centre in Victoria offers viewers a glimpse into the inner world of individuals living with conditions such as psychosis and mood disorders. As a publicly accessible celebration of artistic talent, the collection challenges the stigma so often associated with mental illness, a notion affirmed by Sukhanova: ‘stigmatization is a breakdown of communication. Art affords a viable alternative: a model of dialogue in which the other is accepted as an equal partner in the communication process’. 11
More recently, attention has been focused on the role of artistic pursuits as a means of alleviating the psychological stress often experienced by those in the medical profession. A 2018 study published in the Journal of General Internal Medicine found that medical students who participated in art programmes displayed increased empathy and emotional intelligence as well as lower rates of ‘burnout’. 12 Working in psychiatry, our engagement with extremes of emotion and exposure to accounts of human suffering can lead to vicarious traumatisation. 13 Art can be a powerful way to offset this process, facilitating the expression and processing of difficult emotions.
Exploring and understanding differences in perception
The question of perception is of central interest to the realms of visual art and psychiatry. A work of art inevitably reflects its creator’s way of seeing the world, be it in the depiction of actual scenes, characters and events, or in offering a lens into an imagined realm. Elements such as colour palette, composition and subject matter imbue a piece of art with its resonant emotional tone and ultimately serve to connect the viewer with the artist’s unique point of view. Sukhanova applies the concept of inter-subjectivity to describe the dynamic interface arising between artist and viewer, highlighting its value as a way of challenging societal stigma: ‘By connecting spectators to meaning . . . art fosters cooperative communication in which dignity and individuality of a mental health patient may be affirmed’. 14
The power of the visual medium to depict abstract themes and to animate deeply subjective experiences is strikingly evident in the oeuvre of Richard Dadd, a 19th-century artist who was diagnosed with a psychotic illness and spent the majority of his adult life involuntarily confined to Bethlem and Broadmoor asylums. In ‘The Fairy Feller’s Master-Stroke’ (Figure 2), Dadd depicts a crowded scene of folkloric characters, rendered in minute detail, calling to mind a Lilliputian hallucination. The composition, whereby the scene extends beyond the margins of the frame, creates a claustrophobic atmosphere and connects us to Dadd’s own intense and overwhelming sensory experiences. The unsettling variations in scale and lack of clear perspective seen in many of Dadd’s paintings reflect both the fantastical and frighteningly disorienting aspects of psychosis.
Dadd, Richard (artist). (1855–1864). ‘The Fairy Feller’s Master-Stroke’ [oil on canvas]. The Tate Collection, Britain. Available from: https://www.tate.org.uk/art/artworks/dadd-the-fairy-fellers-master-stroke-t00598.
In psychiatry, as in art, an understanding of the way an individual perceives the world is of vital importance. Distortions of perception are a common feature of mental illness, from the sombre shadow cast by depressive states to the vivid hallucinations of florid psychosis. In our engagement with patients, we strive to describe and interpret the different ways in which individuals see the world, a process that not only facilitates diagnosis but can also foster empathy and understanding.
Conclusion
Art and psychiatry both deal with the external representation of abstract inner states, necessitating the careful analysis and deconstruction of outward appearances in the pursuit of their deeper emotional significance. Furthermore, both disciplines offer a window into the ways in which others perceive the world. Beyond these conceptual commonalities, art has great therapeutic value in psychiatric practice, allowing patients and clinicians to express complex emotions, and enhance psychological flexibility and self-agency.
