From Schizophrenia to Creativity* S I L V A N O

A R I E T I ,

M.D.t

New

York,

N.Y.

T h e schizophrenic phenomenon can be studied i n t w o m a j o r aspects. T h e first is that of altered relatedness, a change w i t h any person other than yourself, to use M a r t i n Buber's t e r m , a change i n the I - T h o u r e l a t i o n , a cleavage between the I and T h o u w h i c h may have its b e g i n n i n g i n some k i n d of difficulty between the c h i l d and the mother. T h e second aspect is the study of schizophrenia p r e d o m i n a n t l y as an intrapsychic phenomenon, a different w a y of u n d e r s t a n d i n g the w o r l d and oneself, because of the adoption of a special type of cognition. I n m y long psychiatric c a r e e r — I guess like most p s y c h i a t r i s t s — I have gone back and forth focusing on one or the other of these t w o aspects, a n d , like most, I have concluded that both these aspects are pertinent, i m p o r t a n t , to be taken f u l l y into account, and to be integrated w i t h each other. L i k e some readers, I have also concluded that these t w o aspects of schizophrenia should not be considered as expressions of static or given phenomena, but as ongoing processes, kept i n m o t i o n by psychodynamic mechanisms, that is, by unconscious m o t i v a t i o n , or by the need to cope w i t h the difficult c i r c u m stances of life. I shall present m y w o r k on schizophrenia i n a l o n g i t u d i n a l order, as i t developed t h r o u g h the various stages of m y life. I hope that you w i l l be w i l l i n g to follow me i n this almost r h y t h m i c alternation i n the study of these t w o dimensions of schizophrenia, and I hope also that you w i l l not object to m y showing you h o w this study led me to investigate the creative process and eventually even to dare to speculate a l i t t l e bit philosophically about this constant state of u n f u l f i l l m e n t and search w h i c h characterizes the h u m a n condition. T h e relevance of t h o u g h t disorders i n schizophrenia has been one of m y basic concerns f r o m the b e g i n n i n g of m y psychiatric studies. A c t u a l l y the o r i g i n of such interest is m u c h more remote i n time t h a n m y reading of Eugene Bleuler's w r i t i n g s . I t goes back to m y studies of the eighteenth*Gutheil

Memorial

L e c t u r e presented at the N i n e t e e n t h E m i l

A . Gutheil

Memorial

Conference of the Association for the A d v a n c e m e n t of P s y c h o t h e r a p y , N o v e m b e r , 1978, on the occasion of receiving the E m i l A . G u t h e i l M e m o r i a l M e d a l . f C l i n i c a l Professor of P s y c h i a t r y , N e w Y o r k M e d i c a l College. Mailing

address:

125 E a s t 84

Street, N e w Y o r k , N . Y . 10028. AMERICAN JOURNAL

490

OF PSYCHOTHERAPY, V o l .

X X X I I I ,

N o . 4, October 1979

F R O M

S C H I Z O P H R E N I A

TO

491

C R E A T I V I T Y

c e n t u r y p h i l o s o p h e r G i a m b a t t i s t a V i c o w h i l e I w a s i n college.

V i c o ' s study

of the cognitive w a y s i n w h i c h the a n c i e n t s , the p r i m i t i v e s , c h i l d r e n , poets, c o n c e i v e of the w o r l d a n d r e s p o n d to it, f a s c i n a t e d m e . in

the m a n y

possible

ways

e x p e r i e n c e s the u n i v e r s e .

by

w h i c h the m i n d

It formed m y interest

faces,

reconstructs,

and

I n m y opinion, V i c h i a n conceptions w e r e a m o n g

the best p r e p a r a t i o n s for u n d e r s t a n d i n g the s c h i z o p h r e n i c r e a l i t y a n d the schizophrenic experience. gist

Heinz

Werner,

A l s o m y d i s c o v e r y of the w r i t i n g s of the p s y c h o l o -

s h o r t l y after

my

arrival

in A m e r i c a , helped

me

to

e v a l u a t e the f u l l r e l e v a n c e of c o g n i t i o n a n d d i r e c t e d m e t o w a r d a c o m p a r a t i v e developmental me.

a p p r o a c h , for w h i c h V i c o ' s w r i t i n g s h a d a l r e a d y p r e p a r e d

B u t i n the t i m e spent i n P i l g r i m S t a t e H o s p i t a l , first as a r e s i d e n t a n d

l a t e r as a staff p s y c h i a t r i s t f r o m N o v e m b e r 1941

to F e b r u a r y 1 9 4 6 ,

I made

s o m e o b s e r v a t i o n s w h i c h led m e i n different a n d u n e x p e c t e d d i r e c t i o n s .

I

d i s c o v e r e d that a few p a t i e n t s w h o r e s i d e d i n b a c k b u i l d i n g s a n d h a d b e e n considered

hopeless

would

apparently

r e c o v e r or i m p r o v e

d i s c h a r g e d , at t i m e s after m a n y y e a r s of h o s p i t a l i z a t i o n . w e r e c o n s i d e r e d cases of " s p o n t a n e o u s r e c o v e r y . "

enough

to

be

A t that t i m e these

I w a s not satisfied w i t h

t h i s e x p l a n a t i o n a n d l o o k e d m o r e d e e p l y into the m a t t e r .

I soon d i s c o v e r e d

that these s o - c a l l e d s p o n t a n e o u s r e c o v e r i e s w e r e not s p o n t a n e o u s at a l l , but the r e s u l t of a r e l a t i o n s h i p w h i c h h a d been e s t a b l i s h e d b e t w e e n the p a t i e n t a n d a n attendant or a nurse.

I m a d e these o b s e r v a t i o n s o n l y i n s e r v i c e s of

f e m a l e p a t i e n t s , but I a s s u m e d that the s a m e s i t u a t i o n c o u l d t a k e p l a c e i n male services. T h e r e l a t i o n s h i p w e n t t h r o u g h t w o stages.

I n the first stage, by g i v i n g

the p a t i e n t s p e c i a l c o n s i d e r a t i o n a n d c a r e , the n u r s e or the a t t e n d a n t h a d m e t s o m e of h e r n e e d s , no m a t t e r h o w p r i m i t i v e they w e r e . improved

somewhat

involvement with her.

a n d the n u r s e h a d d e v e l o p e d

T h e patient h a d

attachment

and

deep

T h e p a t i e n t soon w o u l d b e c o m e the pet of the n u r s e .

I n a s e c o n d stage the p a t i e n t h a d b e c o m e a b l e to h e l p the n u r s e w i t h the w o r k o n the w a r d .

T h o s e w e r e w a r y e a r s , w i t h a c u t e s c a r c i t y of p e r s o n n e l , a n d

any help w a s very welcome. exchange

T h e p a t i e n t w o u l d t h e n be p r a i s e d , a n d a n

of a p p r o v a l , affection,

and reliability w a s established.

I n this

c l i m a t e of e x c h a n g e of w a r m t h a n d c o n c e r n the p a t i e n t h a d i m p r o v e d to the point of b e i n g s u i t a b l e for d i s c h a r g e . Much

to m y r e g r e t , h o w e v e r , I o b s e r v e d t h a t a l m o s t i n v a r i a b l y these

formerly

r e g r e s s e d p a t i e n t s w o u l d soon r e l a p s e a n d be r e a d m i t t e d to the

hospital.

O u t s i d e they w e r e not a b l e to " m a k e i t . "

impressed

by

Nevertheless, I was

the fact t h a t even a n a d v a n c e d s c h i z o p h r e n i c p r o c e s s

had

p r o v e d to be r e v e r s i b l e o r c a p a b l e of b e i n g f a v o r a b l y i n f l u e n c e d by a h u m a n contact. perhaps

T h e s e w e r e q u i t e a d v a n c e d n o t i o n s at t h a t t i m e . methods could

be d e v i s e d by

which we

I thought

c o u l d h e l p the

that

patient

m a i n t a i n , i n c r e a s e , s t r e n g t h e n the a c h i e v e d a m e l i o r a t i o n , e v e n o u t s i d e of the

492

A M E R I C A N

hospital environment.

J O U R N A L

OF

P S Y C H O T H E R A P Y

T h o u g h of c o u r s e , I h a d no i d e a h o w to do it, I h a d

n e v e r t h e l e s s l e a r n e d that w h a t e v e r benefit the p a t i e n t c o u l d r e c e i v e , h a d to c o m e f r o m h i s b o n d s w i t h at least one o t h e r h u m a n b e i n g .

It w a s something

that n e i t h e r V i c o , n o r B l e u l e r , n o r W e r n e r c o u l d t e a c h m e . so

difficult

professional

to

establish

a

human

bond

level; a n d F r e u d , w h o m

with

the

I t s e e m e d to be

schizophrenic,

at

I r e a d w i d e l y , d i d not s e e m

a

much

i n t e r e s t e d i n the subject. D u r i n g the S e c o n d W o r l d government war we

War

many

people w e r e compelled

to r e m a i n i n t h e i r j o b s for the d u r a t i o n of the w a r .

became

free to c h a n g e j o b s ,

and

I r e t u r n e d to N e w

by

After York

the the as a

p r a c t i t i o n e r a n d c a n d i d a t e at T h e W i l l i a m A l a n s o n W h i t e I n s t i t u t e , w h e r e I k n e w it w a s p o s s i b l e to r e c e i v e w h a t I w a n t e d : that i n t e r p e r s o n a l a p p r o a c h w h i c h I h a d a l r e a d y u n d e r s t o o d w a s so i m p o r t a n t e v e n for the s c h i z o p h r e n i c . A n d at the W h i t e

I n s t i t u t e w e r e the p e o p l e a b o u t

m u c h , whose writings I had admired, and w h o m person.

whom

I h a d h e a r d so

I w a s eager to m e e t i n

I refer to H a r r y S t a c k S u l l i v a n , C l a r a T h o m p s o n , E r i c h

and many

others.

A t the W h i t e

I n s t i t u t e I l e a r n e d that one

Fromm,

becomes a

p e r s o n by v i r t u e of r e l a t i o n s w i t h o t h e r h u m a n b e i n g s a n d not of i n b o r n instinctual drives.

I h a v e not yet m e n t i o n e d

Frieda

Fromm-Reichmann,

a n d yet it w a s p a r t i c u l a r l y h e r t e a c h i n g w h i c h I w a s s e a r c h i n g for.

She was

the one f r o m w h o m I h a d to l e a r n those m o d a l i t i e s w h i c h w o u l d m a i n t a i n i n a state of r e m i s s i o n the p a t i e n t s w h o s e t e m p o r a r y i m p r o v e m e n t I h a d seen at P i l g r i m State H o s p i t a l . T h e t e a c h i n g of F r i e d a F r o m m - R e i c h m a n n w a s v e r y u s e f u l .

I learned

f r o m h e r that the c o u n t l e s s w a y s , the i n f i n i t e n u a n c e s w i t h w h i c h p e o p l e love o r h a t e , h e l p o r h u r t one a n o t h e r , i n no o t h e r c o n d i t i o n c a n be better o b s e r v e d t h a n i n the s t u d y of the s c h i z o p h r e n i c d i s o r d e r .

Fromm-Reichmann

1

was

a m o n g the first to e m p h a s i z e that the s c h i z o p h r e n i c is not o n l y a l o n e i n h i s w o r l d , but a l s o l o n e l y .

H i s l o n e l i n e s s h a s a long a n d s a d h i s t o r y .

Contrary

to w h a t m a n y p s y c h i a t r i s t s u s e d to b e l i e v e , the p a t i e n t is not h a p p y w i t h h i s w i t h d r a w a l but is r e a d y to r e s u m e i n t e r p e r s o n a l r e l a t i o n s , p r o v i d e d that h e finds

a p e r s o n w h o is c a p a b l e of r e m o v i n g the s u s p i c i o u s n e s s a n d d i s t r u s t

that o r i g i n a t e d w i t h the first i n t e r p e r s o n a l r e l a t i o n s a n d m a d e h i m f o l l o w a solitary path. Not

o n l y f r o m F r o m m - R e i c h m a n n , but f r o m the w h o l e f a c u l t y at the

W h i t e I n s t i t u t e I l e a r n e d that a c h a r a c t e r i s t i c u n i q u e to the h u m a n r a c e — prolonged

childhood w i t h consequent

extended

dependency

on adults a n d

n e e d of l a s t i n g a n d solid i n t e r p e r s o n a l r e l a t i o n s — i s the b a s i s of the p s y c h o d y n a m i c s of s c h i z o p h r e n i a .

W h a t o c c u r s at a n y

subsequent

age

is a l s o

r e l e v a n t a n d m a y b r i n g a b o u t the d e c i s i v e t u r n s of events that t r i g g e r the psychosis.

T h e childhood situation, however, provides preparatory

factors

that h a v e a f u n d a m e n t a l r o l e i n a s m u c h as they n a r r o w the r a n g e of c h o i c e s of

F R O M

life

S C H I Z O P H R E N I A T O

directions,

thwart

493

C R E A T I V I T Y

the possibility

of c o m p e n s a t i o n ,

determine

basic

o r i e n t a t i o n s , a n d f a c i l i t a t e a b n o r m a l s e q u e n c e s o f events. I n s u m m a r y , m y t r a i n i n g at t h e W h i t e I n s t i t u t e t a u g h t m e to s t u d y t h e w o r l d w h i c h the c h i l d meets a n d t h e c h i l d ' s w a y of e x p e r i e n c i n g that w o r l d , e s p e c i a l l y i n its i n t e r p e r s o n a l a s p e c t s . to o n e a n o t h e r . psychodynamics

I w a s able

thus

I t a l s o taught m e w h a t p e o p l e c a n do to a t t e m p t

of s c h i z o p h r e n i a .

some formulations

I was gradually

filling

of t h e

the n u m e r o u s

g a p s a n d d o u b t s that m y o r i g i n a l o b s e r v a t i o n s at P i l g r i m S t a t e H o s p i t a l h a d left i n m e .

A l l t h i s for t h e good.

B u t soon o t h e r d o u b t s s t a r t e d to c r e e p i n ,

a n d I s a w different types of g a p s .

B y s t r e s s i n g the i n t e r p e r s o n a l , S u l l i v a n

a n d t h e i n t e r p e r s o n a l school d i d not i n t e n d to s u b t r a c t the i n t r a p s y c h i c , b u t i n p r a c t i c e m a n y S u l l i v a n i a n s d i d so.

T h e y focused o n t h e i n d i v i d u a l a s i f h e

w e r e a t a b u l a r a s a m o l d e d p a s s i v e l y by t h e i n t e r p e r s o n a l events of h i s life. A l t h o u g h by n o s t r e t c h of the i m a g i n a t i o n s h o u l d i n t e r p e r s o n a l t h e o r i e s be c o n f u s e d w i t h b e h a v i o r i s m , the stress w a s o n the r e l a t i o n w i t h the e x t e r n a l w o r l d , a n d o n the r e s p o n s e to s u c h r e l a t i o n . least i n t h e o r e t i c a l c o n c e p t i o n s . is

strongly

influenced

T h e i n n e r self w a s neglected, at

I t is t r u e that i n a s m u c h a s the h u m a n b e i n g

by the e n v i r o n m e n t ,

especially

his interpersonal

e n v i r o n m e n t , w e m u s t a c k n o w l e d g e i n h i m a f u n d a m e n t a l state of ty.

receptivi-

B u t I felt that h e c a n n o t be d e f i n e d o n l y i n t e r m s of a state of r e c e p t i v i t y .

Every human

being, even i n early childhood, h a s another basic

w h i c h w e c a n c a l l integrative w o r l d not o n l y i n f o r m

function

activity.

J u s t a s the t r a n s a c t i o n s w i t h t h e

but transform

the i n d i v i d u a l , w i t h h i s i n t e g r a t i v e

a c t i v i t y t h e i n d i v i d u a l t r a n s f o r m s these t r a n s a c t i o n s a n d i n h i s t u r n h e is informed

a n d transformed

by these

transformations.

received like a direct a n d i m m u t a b l e message.

No

i n t e r p e r s o n a l a n d i n t r a p s y c h i c d i m e n s i o n s go b a c k a n d f o r t h . I could

find

influence

is

M u l t i p l e processes i n v o l v i n g I t h o u g h t that

t h e c l u e to this i n t e g r a t i v e a c t i v i t y i n c o g n i t i o n ,

a n a r e a of

p s y c h o l o g y w h i c h w a s l o o k e d u p o n w i t h g r e a t s u s p i c i o n i n t h e late 4 0 ' s a n d early 50's, w h e n either behaviorism, instinctual F r e u d i a n i s m , or interpersonalism prevailed. Heinz

Werner,

I w e n t b a c k t h e n not o n l y to m y G i a m b a t t i s t a V i c o a n d

but immersed

myself

also

in Hughlings

Jackson,

Kurt

G o l d s t e i n , J e a n P i a g e t , S u s a n n e L a n g e r , K a s a n i n , V o n D o m a r u s , a n d the Russian Vygotsky.

I r e p e a t , t h i s w a s d u r i n g t h e late 4 0 ' s a n d e a r l y 5 0 ' s .

M y a p p r o a c h a i m e d at finding s t r u c t u r a l f o r m s for a p s y c h o d y n a m i c content. T h i s a p p r o a c h , w h i c h I called s t r u c t u r a l or p s y c h o s t r u c t u r a l , w a s developed i n d e p e n d e n t l y a n d a l o n g different l i n e s f r o m the s t u d i e s of Lévi-Strauss, a n d p r e c e d e d C h o m s k y ' s a p p l i c a t i o n of s t r u c t u r a l i s m to o t h e r fields of i n q u i r y . The

topic o n w h i c h I focused

schizophrenia.

I w a s t a l k i n g about. who

m y research w a s thought

disorder i n

N e e d l e s s to s a y , at that t i m e m o s t p e o p l e d i d not k n o w w h a t A few d i d , however.

i n 1948 accepted

O n e of t h e m w a s D a v i d R i o c h ,

e n t h u s i a s t i c a l l y m y p a p e r o n t h e s p e c i a l logic of

494

A M E R I C A N

J O U R N A L

OF

P S Y C H O T H E R A P Y

schizophrenia for p u b l i c a t i o n i n the j o u r n a l Psychiatry. T h a t paper opened for me the possibility of w r i t i n g a book, and i n 1955 the first edition of Interpretation of Schizophrenia appeared. I n that book I tried to f o r m u l a t e a psychodynamics of schizophrenia, as I had learned mostly at the W h i t e I n s t i t u t e , and to integrate such formulations w i t h m y cognitive-structural studies. 2

PRIMARY

PROCESS

COGNITION

I n the space at m y disposal here i t is impossible for me even to summarize m y w o r k on schizophrenic c o g n i t i o n , " w h i c h I called paleologic or p r i m a r y 2

process cognition.

5

I shall l i m i t myself to a few points w h i c h have relevance

to the rest of this presentation. Identity

vs.

Similarity

W h a t to the n o r m a l m i n d is only a state of s i m i l a r i t y becomes for the schizophrenic cognition a state of i d e n t i t y . I n other words, t w o subjects are considered identical i f they have a p a r t , an a t t r i b u t e , or a characteristic i n common. T h e patient focuses on that s i m i l a r i t y and overlooks everything else. W h e n the schizophrenic t h i n k s i n a t y p i c a l l y schizophrenic w a y , he identifies not by v i r t u e of identical subjects, as A r i s t o t e l i a n logic requires, but by v i r t u e of identical predicates, that is, as V o n D o m a r u s * f o r m u l a t e d i n his p r i n c i p l e . As we shall see f r o m the examples that f o l l o w , this need to identify subjects w h i c h should not be identified is extremely strong i n the schizophrenic and has at least t w o motivations or purposes. T h e first is of a general character: that of r e c a p t u r i n g some order or cognitive organization i n the confused or fragmented schizophrenic w o r l d ; the second, specific i n each patient, is to believe as true and r a t i o n a l w h a t he wishes to be t r u e . F o l l o w i n g are examples i l l u s t r a t i n g this thought process: An example that I often quote is that of a patient who thought she was the Virgin M a r y . Asked why, she replied, " I am a virgin; I am the Virgin M a r y . " The common predicate "being virgin" led to the identification of the two subjects, the Virgin M a r y and the patient. Obviously the patient had the need to identify with the Virgin M a r y , who was her ideal of perfection and to whom she felt close. At the same time she had the need to deny her feeling of unworthiness and inadequacy. A red-haired, 24-year-old woman in a postpartum schizophrenic psychosis developed an infection in one of her fingers. The terminal phalanx was swollen and red. She told the therapist a few times, " T h i s finger is me." Pointing to the terminal phalanx she said, " T h i s is my red and rotten head." She did not mean that her finger was a representation of herself, but, in a way incomprehensible to us, really herself or an actual duplicate of herself. *For a full description, explanation, and meaning of Von Domarus principle see references 2-4.

F R O M

S C H I Z O P H R E N I A

T O

C R E A T I V I T Y

495

Another patient believed that the two men she loved in her life were actually the same person, although one lived in Mexico City and the other in New York. I n fact both of them played the guitar and both of them loved her. By resorting to a primitive cognition which followed the principle of Von Domarus, she could reaffirm the unity of the image of the man she wanted to love. I n A r i s t o t e l i a n logic, only like subjects are identified. T h e subjects are fixed; therefore, only a l i m i t e d n u m b e r of deductions are possible. In p r i m a r y process t h i n k i n g the predicates lead to the identification. Since the predicates of the same subject are numerous, the deduction reached by this type of t h i n k i n g is not easy to predict. T h e choice of the predicate w h i c h w i l l lead to the identification is psychodynamically determined by conscious or unconscious m o t i v a t i o n a l trends. Significance

of

Words

A n o t h e r characteristic of p r i m a r y process cognition is the change i n the significance of words. T h e y lose part of their connotation; they may not refer to a class any more, but the v e r b a l i z a t i o n , that is, the w o r d as a phonetic entity, independent of its m e a n i n g , acquires prominence. O t h e r p r i m a r y process mechanisms may take place after attention has been focused on verbalization. I n m a n y expressions of patients w h o t h i n k according to p r i m a r y process cognition, t w o or more objects or concepts are identified because they can be represented by the same w o r d . T h e verbal symbol thus becomes the i d e n t i f y i n g predicate. T h i s leads to w h a t seems to be plays on words. F o r instance, a patient w h o was asked to define the w o r d " l i f e " started to define Life magazine. A n I t a l i a n patient, whose name was Stella, thought she was a fallen star. A n o t h e r patient t h o u g h t she was black like the night. H e r name was L a i l a , w h i c h means " n i g h t " i n H e b r e w . A n A m e r i c a n patient whose name was M a r c i a thought she was a rotten person. I n I t a l i a n , a language she k n e w w e l l because she had spent her childhood i n I t a l y , the w o r d marcia means " r o t t e n . " A t times the patient loses the proper denotation of a w o r d and gives i t another one that is suggested by the verbalization. F o r instance, a patient w h o was shown a pen and asked to name the object r e p l i e d , " A p r i s o n . " T h e w o r d " p e n " elicited i n h i m the idea of the slang w o r d for penitentiary. O f t e n the verbalization is exploited to fit certain preoccupations of the patient. F o r instance, every t i m e one patient heard the words " h o m e " and " f a i r , " he thought they were the slang expressions for homosexuals, " h o m o " and " f a i r y . " Concretization A n o t h e r p r i m a r y process mechanism, common to dreams and to schizop h r e n i a , is the concretization of the concept.

I n schizophrenia concepts

496

A M E R I C A N

J O U R N A L

O F

P S Y C H O T H E R A P Y

w h i c h c a n n o t be e n d u r e d by the p a t i e n t a s long a s he u s e s t h e m at a n a b s t r a c t level a r e t r a n s l a t e d into concrete r e p r e s e n t a t i o n s .

F o r instance, a patient

h a d t h e d e l u s i o n that h i s w i f e w a s p o i s o n i n g h i s food.

H e h a d a gustatory

h a l l u c i n a t i o n w h i c h m a d e h i m taste p o i s o n i n h i s food.

T r e a t m e n t revealed

that t h e p a t i e n t w a s a c t u a l l y e x p e r i e n c i n g a g e n e r a l s i t u a t i o n i n w h i c h h e felt his

wife

was "poisoning"

hallucination.

had an

olfactory

H e s m e l l e d a " b a d o d o r " e m a n a t i n g f r o m h i s body.

h i s life.

Another

H e was

c o n c e r n e d at a n a b s t r a c t level w i t h h i s c h a r a c t e r .

patient

H e felt h e w a s a " s t i n k e r . "

I n m a n y of m y w r i t i n g s I h a v e i l l u s t r a t e d h o w m a n y d e l u s i o n s a n d i d e a s of r e f e r e n c e of the s c h i z o p h r e n i c c a n be i n t e r p r e t e d f r o m a f o r m a l o r s t r u c t u r a l point of v i e w a s c o n c r e t i z a t i o n s of concepts o r as a p p l i c a t i o n s of the V o n Domarus

principle.

Other

delusions

derive

from

a n altered

relation

b e t w e e n the c o n n o t a t i o n a n d the v e r b a l i z a t i o n o r v e r b a l s y m b o l s .

Hallucinations A n o t h e r problem w h i c h h a s interested me concerns hallucinations, w h i c h I feel c a n n o t be s t u d i e d e x c l u s i v e l y f r o m the point o f v i e w of t h e i r content. Let

us assume

prostitute.

that a p a t i e n t h e a r s a n h a l l u c i n a t o r y voice c a l l i n g h e r a

W e m a y s a y that the voice r e p r e s e n t s h e r g u i l t ,

outside of h e r s e l f .

externalized

O n e c a n a l s o s a y that the voice r e p r o d u c e s the e a r l y voice

of h e r m o t h e r : " J o a n , y o u act l i k e a prostitute w h e n y o u u s e so m u c h l i p s t i c k . / k n o w w h a t y o u a r e g o i n g to b e . "

T h i s i n t e r p r e t a t i o n h a s a r i n g of t r u t h ,

but the m a r k of s c h i z o p h r e n i a h e r e is not the a b n o r m a l r e l a t i o n w i t h the mother.

T h e a b n o r m a l r e l a t i o n w i t h the m o t h e r c o u l d h a v e r e v e a l e d itself

l a t e r a s i n s e c u r i t y , e x c e s s i v e a n x i e t y , o r s t r o n g g u i l t f e e l i n g , b u t i n s t e a d it m a n i f e s t e d itself as a n u n u s u a l m e c h a n i s m , i n d e e d , a s c h i z o p h r e n i c s y m p tom.

S o m e t h i n g w h i c h h a d been i n t r o j e c t e d b e c a m e e x t e r n a l i z e d a g a i n as a

voice,

a pseudo-perception

coming

from

the e x t e r n a l

world.

I t is t h u s

n e c e s s a r y to s t u d y the m e c h a n i s m not o n l y i n its c o n t e n t , but i n its s p e c i a l cognitive s c h i z o p h r e n i c f o r m . I s h a l l m e n t i o n o n l y a n aspect of s c h i z o p h r e n i c h a l l u c i n a t i o n s w h i c h h a s a l w a y s i n t r i g u e d m e v e r y m u c h : t h e difficult c o r r i g i b i l i t y of the e x p e r i e n c e o r the i n a b i l i t y o f the n o n t r e a t e d p a t i e n t to r e c o g n i z e that the h a l l u c i n a t i o n is a false p e r c e p t i o n h a v i n g no f o u n d a t i o n i n r e a l i t y . nates, his thoughts

W h e n the p a t i e n t h a l l u c i -

regress to the p e r c e p t u a l l e v e l ; a n d it is o n l y w i t h t h e

m e a n s a v a i l a b l e at that l e v e l , that i s , w i t h h i s p e r c e p t i o n s , that h e e v a l u a t e s w h a t h a p p e n s to h i m .

I n the first e d i t i o n of Interpretation

of

Schizophrenia

2

I stressed this i n a b i l i t y of the p a t i e n t to r e c o g n i z e t h e u n r e a l i s t i c n a t u r e of t h e h a l l u c i n a t i o n s , u n l e s s , of c o u r s e , h e r e c o v e r s . that I w a s w r o n g .

M y further studies

proved

T h e schizophrenic patient, d u r i n g psychotherapy, c a n

correct h i s h a l l u c i n a t o r y experiences.

A s a m a t t e r o f fact, w i t h a s p e c i a l

p r o c e d u r e w h i c h I h a v e d e v i s e d a n d w h i c h I a m g o i n g to d e s c r i b e ,

many

F R O M

S C H I Z O P H R E N I A

TO

C R E A T I V I T Y

497

patients are now able to recognize the u n r e a l i t y of the experience. I n w h a t follows I shall take into consideration only a u d i t o r y hallucinations, but the same procedures could be applied to other types of hallucinations after the proper modifications have been made. W i t h the exception of patients w h o are at a very advanced stage of the illness or w i t h w h o m no relatedness whatsoever can be reached, it is possible to recognize that the h a l l u c i n a t o r y voices occur only i n p a r t i c u l a r situations, that is, when the patient expects to hear them. F o r instance, a patient goes home after a day of w o r k and expects the neighbors to talk about h i m . As soon as he expects to hear t h e m , he hears them. I n other words, he puts himself i n w h a t I have called the listening attitude. I f we have been able to establish not only contact but relatedness w i t h the patient, he w i l l be able under our direction to distinguish t w o stages: that of the listening attitude and that of the h a l l u c i n a t o r y experience. A t first he may protest vigorously and deny the existence of the t w o stages, but later he may make a little concession. H e w i l l say, " I happened to t h i n k that they w o u l d t a l k , and I proved to be r i g h t . T h e y were really t a l k i n g . " A few sessions later another step f o r w a r d w i l l be made. T h e patient w i l l be able to recognize and to a d m i t that there was a brief i n t e r v a l between the expectation of the voices and the hearing of the voices. H e w i l l still insist that this sequence is p u r e l y coincidental, but eventually he w i l l see a connection between his p u t t i n g himself into the listening attitude and his actually hearing. T h e n he w i l l recognize that he puts himself into this attitude w h e n he is i n a p a r t i c u l a r situation or i n a p a r t i c u l a r mood, for instance, a mood on account of w h i c h he perceives h o s t i l i t y , almost i n the a i r . H e has the feeling that everybody has a disparaging attitude t o w a r d h i m ; then he finds corroboration for this attitude of the others; he hears t h e m m a k i n g unpleasant remarks about h i m . A t times he feels inadequate and worthless, but he does not sustain this feeling for more t h a n a fraction of a second. T h e self-condemnation almost automatically induces h i m to p u t himself into the listening attitude, and then he hears other people condemning h i m . W h e n the patient is able to recognize the relation between the mood and p u t t i n g himself into the listening a t t i t u d e , a great step has been accomplished. H e w i l l not see himself any longer as a passive agent, as the v i c t i m of a strange phenomenon or of persecutors, but as somebody w h o still has a great deal to do w i t h w h a t he experiences. M o r e o v e r , i f he catches himself i n the listening a t t i t u d e , he has not yet descended to or is not yet using a b n o r m a l or paleologic ways of t h i n k i n g f r o m w h i c h i t w i l l be difficult to escape. H e is i n the process of f a l l i n g into the seductive t r a p of the w o r l d of psychosis but may still resist the seduction and r e m a i n i n the w o r l d of r e a l i t y . H e w i l l intercept the mechanism; he acquires the power to do so.

498

A M E R I C A N

J O U R N A L

O F

P S Y C H O T H E R A P Y

I f an atmosphere of relatedness and u n d e r s t a n d i n g has been established, patients learn w i t h not too m u c h difficulty to catch themselves i n the act of p u t t i n g themselves into the listening attitude at the least disturbance, several times d u r i n g the day. A l t h o u g h they recognize the phenomenon, they sometimes feel that i t is almost an automatic mechanism w h i c h they cannot prevent. E v e n t u a l l y , however, they w i l l be able to control i t more and more. Even then, there w i l l be a tendency to resort again to the listening attitude and to the h a l l u c i n a t o r y experiences i n situations of stress. T h e therapist should never tire of e x p l a i n i n g the mechanism to the patient again and again, even w h e n such explanations seem r e d u n d a n t ; they seldom are, as the symptoms may reacquire an almost irresistible attraction. Schizophrenogenic

Mother

A n o t h e r major g r o u p of m y researches consisted of d e t e r m i n i n g h o w special cognitive processes and conceptualizations of the patient alter the influences of the external w o r l d and b r i n g about i n the patient t r a n s f o r m a tions w h i c h by m a n y authors have been mistaken as f a i t h f u l representations of reality. I shall e x p l a i n w h a t I mean i n reference to one c r u c i a l l y i m p o r t a n t issue: the concept of the so-called schizophrenogenic mother. T h e mother of the schizophrenic has been described as a malevolent creature deprived of m a t e r n a l feeling. J o h n Rosen ' spoke of her perverse sense of motherhood. She has been called a monstrous h u m a n being. A t times i t is indeed difficult not to make these negative appraisals because some examples, considered t y p i c a l , seem to us to fit that image. Q u i t e often, however, an u n w a r r a n t e d generalization is made. T h e mother of the patient is not a monster or an evil-doer, b u t a person w h o has been overcome by the difficulties of l i v i n g . These difficulties have become enormous because of her u n h a p p y m a r r i a g e , b u t , most of a l l , because of her neurosis and the neurotic defenses that she b u i l t u p i n interacting w i t h her c h i l d r e n . M o r e over, we must remember that the studies of these mothers were made at a historical time w h i c h i m m e d i a t e l y preceded the women's l i b e r a t i o n era. I n other words, they were made i n a period d u r i n g w h i c h the w o m a n had to contend f u l l y b u t most of the time tacitly w i t h her n e w l y emerged need to assert e q u a l i t y . She could not accept submission any longer, a n d yet she strove to f u l f i l l her t r a d i t i o n a l role. These are not j u s t social changes; they are factors w h i c h enter into the i n t i m a c y of f a m i l y life and complicate the parental roles of both mothers and fathers. 6

7

I n the last eighteen years I have compiled some private statistics a n d , a l t h o u g h personal biases cannot be excluded and the overall figures are too small to be of definite value, I have reached the tentative conclusion that only a p p r o x i m a t e l y 25 percent of the mothers of schizophrenics fit the image of the schizophrenogenic mother. I actually w o u l d be more i n c l i n e d to say that

F R O M

S C H I Z O P H R E N I A

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C R E A T I V I T Y

499

only 20 percent correspond to this image, but I have included d o u b t f u l cases and conceded a m a x i m u m of 25 percent. A p p r o x i m a t e l y 75 percent of the mothers do not fit this image. I then asked myself w h y these mothers have been portrayed i n this intensely negative, j u d g m e n t a l w a y . W h y do we find such descriptions i n the w r i t i n g s of such different people as S u l l i v a n , Rosen, Hill, Lidz, L a i n g , and, I must r e l u c t a n t l y a d m i t , Silvano Arieti? I t w o u l d be too easy and certainly inaccurate to t h i n k that a l l of us had personal psychologic needs to generalize to a l l cases w h a t occurs i n only a m i n o r i t y of t y p i c a l cases. 8,9

6,7

1 0

1 1

1 2

2

O f course, one could say that I have been led to e r r o r i n m y calculations. T h e " m o n s t e r s " w o u l d have succeeded once again i n h i d i n g f r o m me their real nature and the subtle, i n t a n g i b l e , invisible w a r and invisible hate w h i c h produced such visible effects. F r a n k l y , I do not believe I have g r o w n so insensitive i n m a n y years of p r a c t i c i n g psychoanalysis and psychotherapy as to become less aware now t h a n i n the past of the invisible w a r and of the invisible hate. Repeated observations have led me to different conclusions. Schizophrenics w h o are at a relatively advanced stage of psychoanalytically oriented therapy often describe their parents, especially the mother, i n these negative terms, the terms used i n the psychiatric l i t e r a t u r e . W e therapists have believed w h a t o u r patients have told us. I n a s m u c h as a considerable percentage of mothers have proved to be that w a y , it was easier for us to make an u n w a r r a n t e d generalization w h i c h included a l l the mothers of the schizophrenics. W e have made a mistake reminiscent of the one made by F r e u d w h e n he came to believe that neurotic patients had been assaulted sexually by their parents. L a t e r F r e u d realized that w h a t he had believed to be t r u e was, i n by far the m a j o r i t y of cases, only the product of the patient's fantasy. T h e comparison is not q u i t e apt, because i n possibly 25 percent of the cases the mothers of schizophrenic patients had really been monstrous, and I do not k n o w w h a t percentage of mothers of nonschizophrenics have been monstrous. I f m y i n t e r p r e t a t i o n is correct, we must find out w h y m a n y patients have transformed the image of the mother or of both parents into one w h i c h is m u c h worse t h a n the real one. I n m y o p i n i o n w h a t happens i n the m a j o r i t y of cases is the f o l l o w i n g : the mother has definite negative characteristics— excessive anxiety, hostility, or detachment. T h e f u t u r e patient becomes p a r t i c u l a r l y sensitized to these characteristics. H e becomes aware o n l y of t h e m because they are the parts of mother w h i c h h u r t and to w h i c h he responds deeply. H e ignores the others. H i s use of p r i m a r y process cognition makes possible and perpetuates this p a r t i a l awareness, this o r i g i n a l part-object r e l a t i o n s h i p , i f one wants to use M e l a n i e K l e i n ' s terminology. T h e patient w h o responds m a i n l y to the negative parts of mother w i l l t r y to

500

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J O U R N A L

OF

P S Y C H O T H E R A P Y

m a k e a w h o l e out of these n e g a t i v e p a r t s , a n d the r e s u l t i n g w h o l e w i l l be a monstrous

t r a n s f o r m a t i o n of m o t h e r .

I n l a t e r stages t h i s n e g a t i v e

image

m a y a t t r a c t o t h e r n e g a t i v e aspects of the o t h e r m e m b e r s of the f a m i l y o r of the f a m i l y c o n s t e l l a t i o n , so t h a t h e r i m a g e w i l l be i n t e n s i f i e d i n h e r n e g a t i v e aspect.

T h i s v i s i o n of m o t h e r is s o m e w h a t u n d e r s t o o d by the m o t h e r ,

r e s p o n d s to the c h i l d w i t h m o r e a n x i e t y a n d h o s t i l i t y .

who

A v i c i o u s c i r c l e is t h u s

organized w h i c h produces progressive a n d intense distortions a n d maladap¬ tations.

W h a t I h a v e s a i d i n r e l a t i o n to the m o t h e r c o u l d , i n a s m a l l e r

n u m b e r of p a t i e n t s , be m o r e a p p r o p r i a t e l y s a i d i n r e f e r e n c e to the f a t h e r . CREATIVITY

Witty

Expressions

I n s t e a d of f o c u s i n g o n m y w o r k o n c o g n i t i o n , I s h a l l devote the last p a r t of m y p a p e r to c r e a t i v i t y . my

work

with

I o w e m y i n t e r e s t i n the c r e a t i v e p r o c e s s a g a i n to

schizophrenics.

It originated

with

my

interest

in

the

a p p a r e n t l y w i t t y e x p r e s s i o n s that I h a v e h e a r d f r o m s c h i z o p h r e n i c p a t i e n t s f r o m the b e g i n n i n g of m y

psychiatric practice.

2

To

be e x a c t , these

witty

e x p r e s s i o n s a r e w i t t y for u s , not for the p a t i e n t , w h o uses t h e m i n c o m p l e t e seriousness.

A p a t i e n t w h o m I e x a m i n e d at P i l g r i m S t a t e H o s p i t a l d u r i n g

the S e c o n d W o r l d

War

told m e that n e x t t i m e the J a p a n e s e a t t a c k e d the

A m e r i c a n s , it w o u l d be a D i a m o n d H a r b o r o r G o l d H a r b o r .

Asked why,

she r e p l i e d , " T h e first t i m e , they a t t a c k e d at P e a r l H a r b o r ; n o w they w i l l a t t a c k at D i a m o n d H a r b o r o r at S a p p h i r e H a r b o r . "

"Do

y o u t h i n k the

J a p a n e s e a t t a c k e d P e a r l H a r b o r b e c a u s e of its n a m e ? " I a s k e d . she r e p l i e d .

" I t was a happy coincidence."

the a d j e c t i v e " h a p p y . "

"No,

no,"

N o t e the i n a p p r o p r i a t e n e s s of

I t w a s a h a p p y c o i n c i d e n c e for h e r b e c a u s e s h e c o u l d

t h e r e b y p r o v e the a l l e g e d v a l i d i t y of h e r p r i m a r y p r o c e s s t h i n k i n g . A p a t i e n t w h o m I e x a m i n e d m a n y y e a r s ago h a d the h a b i t of o i l i n g h e r body.

W h e n a s k e d w h y , s h e r e p l i e d , " T h e h u m a n body is a m a c h i n e a n d

h a s to be l u b r i c a t e d . "

T h e w o r d " m a c h i n e , " a p p l i e d i n a f i g u r a t i v e sense to

the h u m a n b o d y , h a d led to the i d e n t i f i c a t i o n w i t h m a n - m a d e T h e patient meant literally w h a t she said. o n l y for u s .

machines.

H e r d e l u s i o n a l r e m a r k is w i t t y

I n t h i s c a s e , too, w e , not the p a t i e n t , c r e a t e the j o k e , b e c a u s e w e

recognize illogicality in her apparent logicality. A n o t h e r p a t i e n t c o m p l a i n e d t h a t t h e r e w e r e t w o i n i t i a l s o n a n office door at h e r p l a c e of e m p l o y m e n t that r e f e r r e d to h e r . t h o u g h t they m e a n t she w a s a n " O l d B a g . " office,

she

Billing." Jesus

conveniently

overlooked

that

T h e y w e r e " O . B . , " a n d she

A l t h o u g h she w o r k e d i n that

they

stood

for

"Ordering

and

A n o t h e r p a t i e n t , w h o m I d i s c u s s e d i n s u p e r v i s i o n , t h o u g h t he w a s

Christ.

When

asked w h y ,

he s a i d , " W e l l ,

I have

h a d so

much

C a r n a t i o n m i l k that n o w I a m r e i n c a r n a t e d . " T h e s e a r e e x a m p l e s of p r i m a r y p r o c e s s c a t c h i n g s i m i l a r i t i e s , of i d e n t i f y -

F R O M

S C H I Z O P H R E N I A

T O

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i n g by virtue of these similarities, i n accordance w i t h the p r i n c i p l e of V o n D o m a r u s , w h i c h I have discussed earlier i n this paper. I d e n t i f y i n g by v i r t u e of identical predicates, i n c l u d i n g identical or s i m i l a r verbal symbols, is one of the most common mechanisms i n that f o r m of creativity w h i c h is w i t . L e t us examine, for instance, a j o k e w h i c h I heard recently: Vito was visiting his old friend Carlo, the Mafia member, in the State penitentiary. "You know, Carlo," he said, "you're just like the Pope. You're Italian, you live in a big house, you can't go out with girls, and you're in for life." I n this joke there are m a n y technical mechanisms involved; one is "representation t h r o u g h the opposite." A M a f i a member, condemned to a life t e r m , is equated w i t h one of the most respected and revered persons i n the w o r l d , the Pope. T r y i n g to identify a subject w i t h its opposite reinforces the effect of the j o k e , but the f u n d a m e n t a l key to the joke is the possibility of i d e n t i f y i n g t w o a p p a r e n t l y u n i d e n t i f i a b l e subjects. One character i n the j o k e , V i t o , a p p a r e n t l y wants to console his old pal C a r l o , w h o has been sentenced to a life t e r m , by i d e n t i f y i n g h i m w i t h no less a person t h a n the Pope himself. H o w can this logical identification be made? By abandoning A r i s t o t e l i a n logic and reverting to the paleologic of the p r i m a r y process, like the logic of the schizophrenic. C a r l o and the Pope become identical because they have some predicates i n common: T h e y are I t a l i a n s , they both live i n a big house, cannot go out w i t h g i r l s , and are " i n for l i f e . " T h e same mechanism is a p p l i e d here as the one a p p l i e d by the patient w h o considered herself the V i r g i n M a r y because she was a v i r g i n , and by the patient w h o thought his w i f e was p u t t i n g poison i n his food w h e n actually he thought she was poisoning his life. The Use of

Metaphor

W e enter thus into a w o r l d where the metaphor is lived as reality. T h e poet of course is a creative person w h o often uses the m e t a p h o r to reinforce his theme. A r i s t o t l e w r o t e , "The greatest thing by far is to be a master of metaphor; it is the one thing that cannot be learnt from others; and it is also a sign of genius, since a good metaphor implies an intuitive perception of the similarity in the dissimilar" {Poetics, 1459a). T h e metamorphosis w h i c h occurs i n dreams and psychosis becomes a metaphor i n poetic creativity. T h e object is t e m p o r a r i l y identified w i t h another because of a common t r a i t or predicate. T h u s , there is an artistic application of the V o n D o m a r u s p r i n c i p l e . F o r instance, a w o m a n is represented as a rose because both the flower and that p a r t i c u l a r w o m a n have at least one a t t r i b u t e i n common: being b e a u t i f u l . I t w o u l d take too long a discussion here to illustrate a l l the processes w h i c h go into the m a k i n g of the metaphor, a topic w i t h w h i c h I have dealt i n m y book Creativity: The

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Magic Synthesis. A t times the poet has almost that capacity for imagery that the dreamer has, or that capacity for "orgies of i d e n t i f i c a t i o n " that the schizophrenic has. I n the m a k i n g of metaphors the poet uses images i n unpredictable ways. F o r example, V i c t o r H u g o , i n his poems, compares the stars i n m u l t i p l e a n d , to the average person, inconceivable ways: to diamonds, other jewels, golden clouds, golden pebbles, lamps, lighted temples, flowers of eternal s u m m e r , silvery lilies, eyes of the n i g h t , vague eyes of the t w i l i g h t , embers of the sky, holes i n a huge ceiling, bees that fly i n the sky, drops of A d a m ' s blood, and even to the colored spots on the t a i l of the peacock. T h e successful metaphor, even w h e n i t seems to subtract f r o m r e a l i t y , adds to o u r understanding and confers aesthetic value. W h e n the poet says A is like B , where nobody else w o u l d be able to see that s i m i l a r i t y , he transports us into a universe where real and u n r e a l unities fuse and gives us a vision of unsuspected depths and dimensions. W h e n Shakespeare, i n Macbeth, writes: 13

. . . Out, out, brief

candle!

Life's

shadow,

That And Told

but a walking struts

and frets

then is heard

no more;

by an idiot, full

Signifying

nothing

a poor

his hour

upon

player the

stage,

it is a tale

of sound

and

fury,

. . .

we perceive a greater, even i f dubious, understanding. T h e poet p u r p o r t s to give us a series of definitions of life. W e r e we to r e m a i n i n the r e a l m of o u r daily r e a l i t y , we could insist that life is not a candle, is not a w a l k i n g shadow, is not a poor player, is not a tale told by an idiot. B u t o u r realism is suspended. A l t h o u g h these definitions of life are not those given i n the dictionary or i n a textbook of biology, we sense that we are getting closer to touching a special t r u t h that o n l y the m e t a p h o r can offer us. T h e metaphor seems to transport us closer to a w o r l d of absolute u n d e r s t a n d i n g that is more real t h a n reality. A t the same t i m e , we are conscious that these words are pronounced by M a c b e t h , the hero of evil, certainly not a m a n to w h o m we should listen as master of life. Is he r i g h t ? Is he w r o n g ? Is this vision of life determined by a life of crime? T h e r e are no sure answers to these questions. T h e metaphors have enlarged the r e a l m of possibilities of o u r understanding. A n o t h e r characteristic that w r i t e r s , especially poets, and people using p r i m a r y process t h i n k i n g have i n c o m m o n , is the use of h o m o n y m y or s i m i l a r i t y of w o r d s , as I have already mentioned. I shall start w i t h a classic example f r o m Shakespeare. I n Shakespeare's Othello, O t h e l l o is a black m a n , a M o o r . A c t u a l l y , i n the o r i g i n a l I t a l i a n story, w r i t t e n by G i o v a n n i Battista G i r a l d i C i n t h i o , f r o m

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w h i c h Shakespeare took the plot, O t h e l l o was a w h i t e m a n , a V e n e t i a n p a t r i c i a n w h o was a lieutenant i n C y p r u s i n the year 1508. C i n t h i o ' s story gives no names, but historical documents indicate that the episodes really took place and that the f a m i l y name of this lieutenant was M o r o . Moro, i n I t a l i a n , means N e g r o or M o o r , but i n the case of this lieutenant, M o r o was his last name and had no reference whatever to his race or color. I t could be that Shakespeare mistook a f a m i l y name for a name r e f e r r i n g to the color of the person involved. I a m more inclined to believe that such coincidence stimulated Shakespeare's mental associations. Shakespeare may have had the i n s p i r a t i o n that i f O t h e l l o were really a M o r o ( M o o r ) or a black m a n , the story w o u l d have an u n c o m m o n artistic twist and the contrast w i t h the f a i r Desdemona w o u l d be accentuated. A real p u n was made of the name Moro. D a n t e , too, resorts to plays on words that, at first impression, are reminiscent of schizophrenic cognition. I n La Vita Nuova, a book consisting of poems and poetic prose, he w r o t e that once he saw Beatrice w a l k i n g on the street preceded by her g i r l f r i e n d G i o v a n n a , w h o was once the beloved of Dante's f r i e n d and fellow poet Cavalcanti. D a n t e w r o t e that G i o v a n n a , because of her beauty, was often called Primavera, w h i c h i n I t a l i a n means " s p r i n g . " D a n t e then makes a peculiar play on words. Primavera signifies for h i m prima verra, w h i c h i n I t a l i a n means "she w i l l come first, before." ( T h a t is, before or preceding Beatrice w h i l e w a l k i n g . ) B u t a second play on words is even more revealing. T h e real name of Beatrice's f r i e n d is G i o v a n n a (the f e m i n i n e of G i o v a n n i or J o h n i n E n g l i s h ) . D a n t e then compared her to J o h n the Baptist, w h o came before or preceded the coming of C h r i s t . T h e u n d e r l y i n g , unconscious m o t i v a t i o n appearing several times i n Dante's w o r k s is his w i s h to identify Beatrice, w h o m he occasionally calls the daughter of G o d , w i t h Jesus C h r i s t . H e wants to make this identification not only i n order to g l o r i f y the object of his love, i n real life a w o m a n named Beatrice, but i n order to t r a n s f o r m his profane or earthly love i n t o a sacred or divine love. D a n t e must resort to the a m b i g u i t y of p r i m a r y process t h i n k i n g i n order to make this identification possible. B u t he knows that this w a y of t h i n k i n g , w h i c h he follows, is not logical. H e knows that i f people believed that he accepted these ideas as t r u e they w o u l d consider h i m insane, b u t he manages to pass the reality test by using a trick made available by his secondary process mechanism. H e says that he does not really believe i n these ideas. H e w r i t e s , " I t seemed that Love spoke i n m y h e a r t " and said those things. H e tells the reader that this is fantasy, but there seems to be l i t t l e doubt that he w o u l d like to believe p a r t , at least, of this fantasy. I regret that lack of space does not p e r m i t me to illustrate how p r i m a r y process mechanisms become available to creative persons, and by c o m b i n i n g

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i n specific ways the secondary process mechanisms they become i n n o v a t i n g powers i n fine a r t , science, religious experiences, l i t e r a t u r e , philosophy, and other fields. I deal w i t h these subjects i n m y book Creativity: The Magic Synthesis. H o w e v e r , I w o u l d l i k e to point out some of the characteristics that schizophrenics and creative people have i n common. I am not r e f e r r i n g to haphazard coincidences but to something w h i c h involves deeply the basic m o t i v a t i o n of these t w o groups of people and the basic w a y by w h i c h the m o t i v a t i o n is mediated. These t w o groups of people, the schizophrenics and the creative persons, are both fugitives f r o m the d a i l y reality i n w h i c h they feel prisoners. T h e ones and the others are shaken by w h a t is t e r r i b l y absent i n this r e a l i t y ; and they send us messages of their o w n search, and samples of their findings. T h e schizophrenic is t e r r i b l y a f r a i d of this planet, of r e m a i n i n g close to the soil, this soil w h i c h w i l l eventually b u r y a l l of us, but he has no wings to fly h i g h into space. H i s flight f r o m reality is a w a y that fits his private, incommunicable feeling, his strictly i n d i v i d u a l i s t i c , bizarre, strange behavior w h i c h does not evoke consensus but may even become destructive to the self and others. H i s t h i n k i n g completely gives vent to the p r i m a r y process, w i t h logical rules w h i c h seem illogical to the usual logical m i n d . T h e creative person also feels a prisoner i n the w o r l d as i t is, as he has found i t , and wants to make some changes to t r a n s f o r m this reality i n order to beautify i t , or to enlarge the field of h u m a n knowledge or experience, or i n order to provide usefulness, understanding, and p r e d i c t a b i l i t y , or to evoke a universal response. T o escape f r o m reality he, too, must resort to the only w a y available to the h u m a n being for this purpose. H e , too, plunges i n t o the archaic recesses of p r i m a r y process cognition, but here the common g r o u n d ends. C o n t r a r y to the schizophrenic, he is able to match harmoniously the p r i m a r y process w i t h the secondary process, that is, w i t h the usual n o r m a l t h i n k i n g of the n o r m a l m i n d , and f r o m this fusion or m a t c h i n g , the creative process or w h a t I call the t e r t i a r y process emerges. T h e t e r t i a r y process is the magic synthesis. T h e t e r t i a r y process, too, requires a certain alteration of the I - T h o u r e l a t i o n , because d u r i n g his creative w o r k the creative person separates himself f r o m the s u r r o u n d i n g w o r l d and becomes intensely aware only of his solitary, intrapsychic processes. B u t this is only a t e m p o r a r y cleavage of the I - T h o u r e l a t i o n , w h i c h u l t i m a t e l y w i l l reinforce the I - T h o u relation w i t h the creative product w h i c h w i l l enrich both the I and the T h o u , the creative person, and a l l the others. T h u s I hope I have demonstrated that, after a l l , i t is not so strange for the psychiatrist to become involved w i t h these t w o so unusual and divergent transformations of r e a l i t y : psychosis and creativity. I f we pursue this area of i n q u i r y i n a l l its ramifications, we become astounded at the vast panorama of h u m a n existence w h i c h becomes available to the psychiatrist. H e can look

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at certain forms of schizophrenia and touch the n a d i r of h u m a n existence; and may explore the harmonized fantasy of the creative person, and participate i n the zenith of h u m a n life. A n d he may also look at the rest of us, most of w h o m are neither creative nor schizophrenic, because like t h e m , we, too, are searchers for the absent and do the best we can i n our petty, customary, secondary process ways. M o r e than anybody else, the psychiatrist knows and rediscovers every day that i n the toil of our existence, a l l of us, both intrapsychically and interpersonally, confront daily our basic needs, aspirations, and troubles. W e are a l l mendicants for love, searchers for new crumbs of t r u t h , for a taste of softness and serenity, or for a patch of beauty.

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Second

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try, 11:325, 1948. Intrapsychic

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Interpretation of S c h i z o p h r e n i a , 2nd. E d . , 1974. Direct

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G r u n e & Stratton, N e w Y o r k , 1953.

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9. 10.

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as a Human

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Press, C h i c a g o , 1955. 11. L i d z , T . T h e Influence of F a m i l y Studies in the T r e a t m e n t of S c h i z o p h r e n i a . 32:273, 12.

L a i n g , R . D . and E s t e r s o n , A .

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From schizophrenia to creativity.

From Schizophrenia to Creativity* S I L V A N O A R I E T I , M.D.t New York, N.Y. T h e schizophrenic phenomenon can be studied i n t w o m a j...
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