Illness and Artistic Creativity

CLEMENS E. BENDA, M.D., is the author of several books and many articles dealing with human development, creativity, and the impact of cultural, emotional, and somatic influences. The following article expands on “The Meaning of Illness,” a chapter in his newest book, THE IMAGE OF LOVE: MODERN TRENDS IN PSYCHIATRIC THINKING, published by the Free Press of Glencoe, Inc.

CLEMENS E. BENDA, M.D.

OVER the centuries, no doubt many great artists have fallen ill, but no record is at hand to indicate whether their illnesses had a significant influence on their creativity. It was only in the nineteenth century that the illnesses of two contemporaries, Friedrich Nietzsche and Vincent van Gogh, both of whom spent considerable time in mental hospitals, gave rise to the question of how their illnesses were related to their work.

“The more I become decomposed,” wrote Van Gogh in one of his letters, “the more sick and fragile I am, the more I become an artist.” Few painters have been so articulate in their expression, and few men have so much insight into their own conditions.

Characteristic of his “mental attacks” was an intensification of his imagery. This intensification of perception occasionally came over Van Gogh in the midst of his work and brought about his representation of inner visions, which assumed a new reality. He found it surprising that he, a modern man who admired Zola, the Goncourts, and modern naturalism, was subject to spells wherein religious ideas assumed a reality previously recorded only by the great religious mystics. He observed the landscape with an emotional depth in which the objects of his perception and his own experience fused together into a new reality, but the experienced bliss was often interrupted by anxiety and fear.

The greatest intensity of Van Gogh’s work fell in the year 1888; 46 of 108 major paintings were done in that year, whereas before 1887 there were only 12. His work decreased after the acute onset of his illness, and somewhat fewer pictures are recorded for 1889 and 1890 than for 1888. Through his letters, we have an accurate account of the change in attitude which took place in the transition from impressionism to his new expressionistic style. In one letter he remarks, “Instead of reproducing exactly what I see, I use the colors arbitrarily in order to express myself more vigorously. I exaggerate the blonde of the hair. I arrive at orange colors, chrome, and light lemon yellow. Behind the head, in place of the ordinary wall of a common room, I paint the infinite. I achieve a background of purest blue, the strongest that I can express, and in this way the blonde radiant head achieves a mystical effect on the background of rich blue like a star in the deep azure. I am groping to find simpler and simpler techniques which may be not impressionistic. I would like to paint so that everyone who has eyes can see with complete clearness. Alas, I call this ‘simplicity of technique.’ ”

With Van Gogh’s case, the problem of the artist and psychiatry suddenly moved into the public eye. Van Gogh’s rather intimate contact with his psychiatrist, Dr. Gachet, testifies to the possibility of a warm and understanding relationship between the artist and science and raises a number of interesting questions. Is illness a factor in modern art? Does sickness support or suppress the creative process? Can Van Gogh’s painting be explained in any way by his illness? Do diagnosis and treatment of mental illness contribute to the understanding of the arts?

Since Van Gogh’s time, a number of great artists, among them the Norwegian painter Edvard Munch, have been known to suffer from mental disturbances. In our age of neurosis, when it is almost a prerequisite to be neurotic if one is to share in the cultural achievement of our times, the relationship between creative art and psychiatry has become even closer.

Munch’s history in many points resembles that of Van Gogh. Born in 1863 as the son of an army surgeon, he spent his childhood in Oslo. His mother died of tuberculosis when he was only five, and his oldest sister, who had been very close to him, also died of tuberculosis, when he was fourteen years old. Munch’s haunting paintings of deathbeds and illness reproduced time and again the impact of these early experiences. Moreover, after the death of his mother, his father turned to religion in a way which was frightening to the children. As an old man, Munch recalled that his father “had a difficult temper, exhibited nervousness with periods of religious anxiety which could reach the borders of insanity as he paced back and forth in his room praying to God. . . . Disease and insanity were the black angels on guard at my cradle. . . . In my childhood I felt always that I was treated in an unjust way, without a mother, sick, and with threatened punishment in Hell hanging over my head.”

Munch was frequently ill during childhood, and poor health often interrupted his attendance at school. At the age of twenty-seven, he was for the first time in a hospital, in France, for several months. From 1892 until 1908 he spent most of his time in voluntary exile abroad, mostly in Berlin, where he gained great success and recognition. In 1908 he had a “complete nervous collapse,” culminating in excessive drinking, which led him into a sanitarium. The crisis which obsessed Munch found its most vivid expression in his painting called Marat’s Death, in which the theme of Samson and Delilah is taken up and interpreted in the massive dead body of a man lying perpendicular with the head toward the left lower edge, while the woman stands “erect and rigid, pressing her arms against her sides, excluding every feeling but that of her own self-justification expressed by the frozen and obsessive determination of her face.”

Munch lived his last thirty years in solitude on the outskirts of Oslo, restricting his contacts to a few close friends.

The cases of Van Gogh and Munch, as well as those of their respective literary contemporaries Nietzsche and Strindberg, prove beyond doubt that illness as such does not necessarily produce creativity, but often destroys the creative process. Moreover, the various forms of mental disturbance have very different effects upon different artists. Illness can give man a detachment and a courage which the average person does not command. Many artists have broken through the narrow bars of conventionality because of illness and have reached new frontiers which could never have been attained without it. An advancing illness often intensifies anxiety and dread, with a resultant increase in creative output. In Van Gogh, the intensification of perceptual experience gave his vision a depth and color of unheard-of power. In Munch, on the other hand, illness caused suspicious withdrawal from friends, with a progressive narrowing of his experience.

WHEN psychiatry became a biological science, scientists, as well as the public, confused the sick artist’s work with his illness and denounced his paintings as fever-sick hallucinations, the output of a morbid mind. Many rather embarrassing studies of a pseudoscientific character are on record. But, in general, this period of psychiatric adventures has now come to an end. With the dawn of psychoanalytical investigations, a new approach to the artist was made. Interest was centered on the unconscious.

Since unconscious dynamics play a very important role in all creative achievements, it is not surprising that works of art attracted psychoanalytical attention. Freud himself did not expect too much from the study of mental illness, but thought that psychoanalysis would unearth significant themes in the work of great painters and writers. His controversial studies of Leonardo da Vinci, of Michelangelo’s Moses, and of Dostoevsky have been equally acclaimed and rejected. Some of his minor disciples could not resist applying the analytical knife to the works and personalities of great artists, and many slipped into the pitfall of identifying creativity with neurosis, concluding that creativity stems from only partially successful sublimation of an unresolved Oedipus complex.

A number of psychoanalytical studies of artists are based on the theory that visual curiosity and the infantile urge to ask questions persist in the artist and philosophical thinker, that the artist continues in an infantile fixation, instead of living like ordinary human beings and taking for granted what life has to offer. One famous analyst wrote that creative people “stop at those early problems of life which give the child cause to ponder: the problems of birth and death, good and evil, aim and purpose of one’s own existence.” The creative artist and philosopher “ponders life instead of living it,” thus failing to achieve a successful “sublimation of his infantile interests and inquisitiveness. [He] reveals by his endless doubting, searching, struggling that he is never done with the primary problems and suffers from them all his life.”

Although the artist is credited with an ability to express his unconscious wealth of fantasy in a manner that “gives pleasure to himself and others,” such achievement is said to be due to narcissism, interpreted as a kind of self-love concentrated on one’s own personality, such as can best be observed in children. On this basis, the creative person lives only for self and concentrates on his ego and his work.

In evaluating the creative process as narcissism, inhibition, and failure to adjust to reality, psychoanalysts have made a serious mistake. Many an artist has feared that psychoanalysis might rob him of his creativity and produce a well-adjusted haberdashery salesman. The confusion between creativity and neurotic inhibition of creative expression unfortunately still exists in artistic circles and in psychiatric literature.

In an industrialized society, adjustment to reality is the main theme of mental health programs, and the best adjustment is often identified with sexual and financial successes. In the light of such ideas, many artists appear as victims of their own mother and father complexes. Not only does the world look down on artists as outsiders who are incapable of social adjustment, but the artists themselves are guilt-ridden and full of anxiety. It is regrettable that psychoanalysis has often reinforced their guilt feelings by overemphasizing the neurotic aspects of their conflicts. Jung and his school have generally avoided these pitfalls and have centered their attention on different aspects of the creative unconscious, achieving considerable understanding of mystic and primitive art.

TO UNDERSTAND the relationship between illness and creativity, one must analyze the essence of creativity and study the effect of pathogenic influences on it. Fortunately, some scientific data are now available. Dr. Charles Hersch and Dr. Leslie Phillips, psychological researchers at Worcester State Hospital, in Massachusetts, have used the conceptual framework of Professor Heinz Werner of Clark University and some of Dr. Anne Roe’s earlier material on artists in an investigation comparing the creative mind with the average mind and with that of the schizophrenic patient. For the creative group they used a sample of eminent painters who have achieved national recognition.

In interpreting the Rorschach ink-blot test, the answers are scored in various categories according to whether movements, forms, colors, or other aspects determine the created image. This enables the psychologist to gain insight into the relative strength of various pressures within the individual and thus understand how he perceives the world and reacts to it. Certain types of answers are considered mature and indicate a high degree of integration, while others suggest emotionality and primitive diffuse emotionalism. Traditional interpretation of the Rorschach test did not permit discovery of creative aspects in the personality, and the misinterpretation of certain types of answers as primitive or regressive added to the confusion. The new study assumes that the creative personality does not operate at a fixed level of function but, rather, varies in its level of performance.

Creativity requires a constant reorganization which cannot be achieved without constant fluctuation or mobility between progressive integration and regressive starting anew. Thus, creativity is a bi-phasic process. The creative artist has to command a flexibility which enables him to differentiate fixed configurations and reorganize the elements in nonexisting new patterns of imagery. And the creative person needs a greater ability to integrate those processes which we identify with maturity, as well as the more primitive personality patterns which enable him to regress and identify with objects on a rather primitive level. These primitive aspects of artistic personalities have often been confused in psychology with primitivity, infantilism, or schizophrenic lack of ego boundaries.

In an era when the unconscious and primitive patterns were the sole object of interest, artists were confused with neurotics and psychotics, who have only this aspect of creativity but lack the formative integration and real creative power. What especially distinguishes the great artist from the average person, and, even more, from neurotic inefficiency and schizophrenic decomposition? Artists give more mature, form-dominant responses than average people do, and both give significantly more integrative responses than the schizophrenics do. On the other hand, artists have more primitive responses than the average on what have been called “primitive” scores, but the artist’s is a different type of primitive response from the schizophrenic’s. Artists excel in the physiognomic responses of both groups.

The investigation showed that artists have a high percentage of mature responses of a specific nature, including movement conceptions, formdominant responses, and primitive thought responses. The nature of their responses indicates that a creative personality is able to shift back and forth between self and environment. First, the boundaries between self and environment can be readily relaxed in a mode of identification. On the other hand, the boundaries are readily reinstated, with self and environment maintaining discrete and polar differentiation.

This research gives new insight into artistic creativity. Creative personalities have greater abilities than ordinary people for both progression and regression in their dealings with the world around them, but the regression in artistic creativity has no connection with the infantile regression of neurosis or mental illness.

ANOTHER fruitful source for a new interpretation of artistic creativity and for the understanding of the influence of illness on the artist has been the experimental production of temporary abnormal or psychotic conditions which subside after a few hours but give the physician an opportunity to observe the subject of the experiment and the subject an opportunity to record the alterations in his own experiences. In connection with Dr. Max Rinkel, I worked with one of the most outstanding Boston painters, who volunteered for two experiments, with lysergic acid and mescalin, respectively, because of his great interest in perceptual phenomena. Here are some excerpts from the observations of the two attending psychiatrists, as well as the self-experience of the painter.

8:20 A.M. Artist takes 60 mg. LSD. Thirty minutes later, feels a little drunk, slight tremor in the left hand. Five minutes later becomes happier, “the effects get stronger. I feel intoxicated.” The tremors come and go in waves, spread over both hands. There is a euphoric mood, and A. gets more talkative, makes notes in his book, “intoxication, increased self-consciousness.” Thirty minutes later, “changes in sensation of mouth and taste.” At 9:28, “When I shift my eyes, everything seems brighter in color,” has sensations in tongue, funny taste, more saliva. At 9:37, sensations of lighter color, values appear, the dark colors look the same. Feels extreme intoxication, momentarily pleasant sensations, but feeling more and more removed as waves come and go. At 9:48 feels “more detached” from himself. His writing changes, contractions of words occur, like “perctly” instead of “perfectly.” Two minutes later the speech changes, too. He has different sensations of space, can see wider angles, everything looks smaller. At 10:18 starts a picture of Dr. R. “This has to be a caricature, not a likeness.” “Hanging skin. You must have been very fat before.” “Eyes: old woman’s look; interesting eye structure.” After two minutes of drawing very happily, “I am not sorry for you. I am sorry for me.” The sensations of space come and go in waves, and space appears alternately removed and nearer. At 10:30 he talks slowly, feels in a “trancelike state,” starts picture of Dr. R. At 10:46 he sits happily and draws, says little, has the sensation of “rapture,” and says, “I could snap out but don’t want to,” At 10:53 feels great excitement. “I could go off in complete fantasy, can’t move around, no feeling of awareness, sensation of floating.”He scribbles, and his drawings become more and more disconnected. His pen gets arrested, and he makes dots instead of lines, looks at his pictures, smiles, “This is nothing.” At 11:04 looks at his fountain pen. “This is like a telegraph pole”; looks at his hands and sees them detached in space. At 11:21, a new picture of Dr. R. Looks at him as “a new man, etheric colors, luminosity itself, feeling of spring, a much younger man.” At 11:24 says to Dr. R., “You take on expressions I feel. You feel spasms?” Has strong sensations of empathy, is completely absorbed in Dr. R. “There is alarming identity between you and me.” At 11:35 feels great buoyancy. “I am glad I am a painter.” At 11:40 starts another drawing of Dr. R.. draws from memory. “I hate to look away from paper. We have gotten off your portrait.” Feels great “efficiency,” is euphoric, “I care less.” But the drawing itself does not progress, and he continues to draw one eye while the rest of the picture is not completed. At 11:52 feelings of ecstasy overcome him, he draws claws of birds, monsters; calls his drawing “monstrous, bizarre, exfoliations.” At 12:17 experiences feelings of increased meaningfulness. Every gesture, every line acquires a great meaning, “I feel floating away.” Looks into space and feels objects moving closer and farther away. Feelings of empathy and identity with his surroundings. The state of transformation persists for about an hour. The top of a head is missing, roaming about masked; laughing sensation. At 12:45, “Too bad to disrupt the sensations, pleasurable feelings, transformation of faces. I always try to hypnotize myself, have never succeeded.” All colors in room have a light pastel coloring. . . . At 2:15 the perception of colors is much increased. Looks at the tablecloth, where there are some reflections from candelabra on ceiling. “Never noticed this before. Violet light with yellow aura around.” At 2:30 the feelings of unreality come in waves, “state of turmoil, no order; chaotic is a better word than turmoil.”

In his own studio, A. experiences the colors more intensely, “as if I noticed them for the first time.” Tries to play his sitar, “It’s tuned, I think.” He has difficulties with coordination of his hands, but “I hear better. Sounds pleasant; Gee, I love the sounds.” but the difficulties in playing increase. “I feel stiffer in playing.” Calls the music “even nicer, sweeter, more human. Identification with sound of instrument is more complete.”Complains that his mind wanders off, looks around with suspicion: “you people, destroying possibility of enjoyment.”Around 3:00 is annoyed by our presence, “could otherwise enjoy myself,”is suspicious. “You are not participating. I see it from your expressions.” Feels suspicion arise, resentment. “You provoke something. Some people don’t like this music. You provoke me to hostile reactions.”After 3:15 the effect of the drugs is gradually petering out. “I am not feeling half as chaotic as in the restaurant.”Feeling wears off. His hands appear to him clammy, moist, cyanotic. His suspiciousness is strong, and he draws monsters and animals. His attention comes and goes. At 4:00 the normal condition is restored, but waves of feelings of unreality are still coming and going at intervals.

These observations are very revealing. In one of his articles, research psychiatrist Max Rinkel summarized a number of his experiments at the Massachusetts Mental Health Center:

The clinical manifestations depended essentially upon the amount of LSD administered. . . . Disturbances of thought processes and distortions of perception were quite common; other manifestations were related to behavior, affect, and mood. Hallucinations, illusions, and delusions did occur occasionally. Depersonalizations, suspiciousness, and paranoid reactions were frequently observed. The occurrence of hostility, often associated with extrapunitive or intrapunitive anger, was made the object of a special study and resulted in the observation (among others) that when the subject was hostile, he tended to devaluate the object, “a diabolical face,” “a young woman looking one hundred years old”; but when the subject’s attitude was affiliative, he tended to overvaluate the object, “big, my very rock of Gibraltar,” or “glowing with youth and health.”

Rorschach tests corroborated clinical observations and demonstrated the subjects’ reduction in organization and integration, loss of emotional control, decrease in orientation to past and future. Anxiety and tension were increased in some individuals and decreased in others, with no consistency for either trend. The individuals apparently were aware of the fact that the LSD experiences were temporary, and insight remained preserved in spite of the drastic intellectual and emotional changes. I wish to stress one thought that bears out observations about the creative personality reported above: the intoxication of the schizogenic agent intensified the inner experiences but broke down the synthetic control functions and reduced the creative expression to doodling and fragmentation of lines. There is a conspicuous discrepancy between the experience of might and grandeur on the one hand and reduction of expressive facilities on the other.

The great artist represents the rare combination of strong unconscious drives with a strange power of controlled and mature integration of experience and the ability to express such order in symbolic forms of painted imagery or poetry. Studies of the unconscious alone will often find the painter near the neurotic, and even schizophrenic, with whom he may share tendencies to daydreaming and increased imagery formation; but in contrast to the ineffectiveness of the neurotic, the artist has strong forces ol integration, control, and creativity at his disposal. It is this ability to transform the imagery into symbolic forms that distinguishes the artist from his less favored contemporaries.

With the new developments in psychodynamic psychiatry, based on social science, psychology, and existential psychiatric thinking, modern psychiatry is much better prepared to deal with the artist and the creative personality in general. Psychiatry now realizes that man’s unconscious forms only one aspect, while his interpersonal, cultural, and spiritual experiences are the formative forces which pattern the whole personality. But beyond stands man’s power of self-expression and realization of his aspirations, and the great artist is the rare personality who is able to transform his shifting experiences into lasting works of art.

Modern psychiatry recognizes the cognitive conscious and creative forces in man as that human attribute which enables him to transcend his emotional impressions and to be the creator of an inner world. Psychiatry can help reinforce and integrate the creative abilities and eliminate those fixations which inhibit the free shift between primitive and mature integrative functions. The painter needs identification in empathy and intuition, but at the same time needs the ability to withdraw and fall back on his own self-differentiation. In the neurotic we often find the anxious defense of one aspect of being. Some people never achieve a strong personality structure because the ego boundaries are too fluctuant. In others, the structure is rigid and compulsively petrified, and these people are never able to reorganize themselves and start anew with unprejudiced attitudes.

Man does not live in a reality common to all; each person lives in his own world, reflected in his imagery. To create this imagery in visual and literary forms, sharable by the creator and beholder alike, is the problem of all great art. In this way the artist and thinker moves again into the center of a civilization. If psychiatry succeeds in making the “outsider” again the true “insider.” the representative of the best in humanity, it will serve the contemporary world in a manner previously denied to medicine.