Schizophrenia
The disjointed thinking that characterizes schizophrenia can inhibit the creative process, but visual art can be an effective means of communication for those living with this complex disorder.
Schizophrenia is a mental disorder, characterized by hallucinations, delusions, disorganized thinking and communication, and psychosis (Mayo Clinic, 2024). Symptoms can be divided into positive and negative symptoms.
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Positive symptoms: Symptoms that entail the presence of something abnormal. In schizophrenia, this often includes hallucinations and delusions. Hallucinations are the perceptions of sensory stimuli that exist only in a person's mind. In other words, a hallucination is when a person sees, hears, feels, tastes, or smells something that is not actually there. In schizophrenia, visual and auditory hallucinations are the most common. Delusions, basically, are beliefs in ideas or supposed facts that are not true. Common in schizophrenia are delusions of control and delusions of persecution. Delusions of control are delusions in which a person falsely believes their thoughts, feelings, and/or behavior are being controlled by some external force (i.e., the government, another person, etc.). Delusions of persecution are delusions in which a person falsely believes that they are being spied on, or harmed, or plotted against to be harmed. A person experiencing this form of delusion may believe that an acquaintance is secretly trying to kill them, for instance.
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Negative symptoms: Symptoms that entail the absence of something normal. In schizophrenia, this often includes disjointed, difficult-to-follow speech. Another negative symptom seen in schizophrenia is catatonia, characterized basically by a lack of perception and control of cognition and behaviors. A person in a catatonic state may not move at all, or move uncontrollably. They may go mute, or make sound uncontrollably. Another common characteristic of catatonia is a lack of response to stimuli.
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Psychosis is a mental state that is removed from reality. Hallucinations, delusions, and catatonia would all fall under this category.
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Background: a drawing made by a man with schizophrenia of his mother and father. This man struggled to communicate verbally with his therapist, but communication was made easier through drawing (Noronha, 2013).
Schizophrenia Diagnostic Criteria (APA, 2013)
Two or more of the following symptoms:
1. Delusions.
2. Hallucinations.
3. Disorganized/incoherent speech.
4. Severely disorganized behavior/catatonia.
Disorganized behavior can look like inappropriate emotional reactions to certain situations and seemingly random movements, among others.
5. Negative symptoms, such as avolition (a lack of motivation/interest in typical, everyday activities) or flat affect (lack of emotional expression)
Symptoms must cause either distress or impairment in daily functioning.
Symptoms must persist for at least 6 months, at least 1 month of which must include symptoms 1, 2, and/or 3.
Symptoms are not better explained by schizoaffective disorder, bipolar disorder with psychotic features, or major depressive disorder with psychotic features.
Symptoms are not better explained by substance use.
Treatment: Risperidone
Risperidone is an antipsychotic drug, aimed generally at treating psychosis in various mental disorders, one of which is schizophrenia (McNeil et al., 2024). It is a second-generation, or atypical, antipsychotic. Second-generation antipsychotics work by blocking receptors of serotonin and dopamine (Chokhawala & Stevens, 2023), excesses of which are correlated with the presence of positive and negative symptoms.
Schizophrenia in the Media: John Nash
A Beautiful Mind is a biopic starring Russell Crowe (top) as famed mathematician John Nash, who had schizophrenia. In the movie, John experiences hallucinations and delusions. While at Princeton University, he imagines the existence of one of his closest friends. He also hallucinates a young niece, and a military official. John is deluded into thinking he has been recruited by this official to work for the US government against the Soviet Union.
While unclear if these were the types of hallucinations and delusions the actual John Nash (bottom) experienced, the general depiction of schizophrenic hallucinations and delusions is fairly accurate.
Neurobiology
MRI studies have shown reductions in gray matter in the prefrontal and temporal lobes of schizophrenia patients (Liu et al., 2020).
The temporal and prefrontal lobes are areas in the brain crucial for episodic and short-term memory, auditory processing, and decision making. A lack of gray matter indicates, simply put, a lack of complex communication networks between neurons (Karlsgodt et al., 2010).
A lack of complex neural communication networks can undoubtedly result in poor communication within areas of the brain, which can lead to misinterpretation of stimuli. Think about the prefrontal and temporal lobes' role in auditory processing, and the frequency of auditory hallucinations in schizophrenia. It makes sense that communication issues in areas of the brain responsible for the processing of sound can mistakenly pick up sounds that are not there.
Schizophrenia and Art
“I fight pain, anxiety, and fear every day, and the only method I have found that relieves my illness is to keep creating art,” said Yayoi Kusama (right) (Lamberg, 2017).
1. For decades, famed Japanese artist Yayoi Kusama has found a reprieve from the distress of her mental illness in the form of artistic creation.
2. It is not clear what specific mental disorder Kusama has, but her hallucinations reminisce schizophrenia.
3. Since she was a young child, Kusama would experience visual and auditory hallucinations, seeing bright auras around objects and hearing plants and animals talk to her. In order to confront the distress caused by her hallucinations, she would draw them.
4. Kusama's illustrious artistic career has spanned decades, coming into contact with a plethora of notable figures in modern and contemporary art, including Georgia O'Keeffe and Roy Liechtenstein.
5. Kusama's life and career are a testament to the therapeutic effects of art upon schizophrenia and schizophrenic symptoms.
6. It is important to note that Kusama's career should not be used as evidence for the "tortured artist" myth. Although her symptoms and distress inspired her work, she did not experience these symptoms so that she could be creative. She is creative so she can deal with the symptoms and distress she experiences.
Background: All the Eternal Love I Have for the Pumpkins, an art installation created by Kusama.
Works Cited (in order of appearance)
Mayo Clinic. (2024, October 16). Schizophrenia - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
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Noronha, K. (2013). Working with Art in a Case of Schizophrenia. Indian Journal of Psychological Medicine, 35(1), 89-92. https://doi.org/10.4103/0253-7176.112215
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
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McNeil, S.E., et al. (2024). Risperidone. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459313/
Chokhawala, K., & Stevens, L. (2023). Antipsychotic Medications. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519503/
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Liu, N., et al. (2020). Characteristics of gray matter alterations in never-treated and treated chronic schizophrenia patients. Translational Psychiatry, 10(136) https://doi.org/10.1038/s41398-020-0828-4
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Karlsgodt, K., H., et al. (2010). Structural and Functional Brain Abnormalities in Schizophrenia. Current Directions in Psychological Science, 19(4) https://doi.org/10.1177/0963721410377601
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Lamberg, L. (2017). Artist Describes How Art Saved Her Life. Psychiatrics News, 52(18) https://doi.org/10.1176/appi.pn.2017.9a21
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