Creativity and Social Support in Mental Health

Service Users' Perspectives

R. McDonnell

• Publisher: Palgrave Macmillan
• Year: 2014
• ISBN:
  9781137345486
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This book weaves together service users' lived experiences of mental health recovery and ideas about how creative activities such as art, music, and creative reading and writing can promote it, particularly within social and community settings.

Part I

Ideas and Evaluation in Creativity and Social Support

1

Creativity and Mental Health

Linking creativity with mental illness

From ancient history and on through the dark and middle ages, philosophers of many persuasions have waxed lyrical on the subject of creativity and a coincidental struggle with mental health. Aristotle is said to have declared that ‘there was never a genius without a tincture of madness’ and the eighteenth-century German scholar Lichtenberg is reported to have commented that the graffiti on the madhouse walls would often be worthy of publication. So the ‘mad genius’ stereotype is an idea that has been proliferating for centuries, an assumption that there is a relationship between high creativity and the potential for emotional breakdown in an individual person (Hare 1987; Storr 1993; Waddell 1998; Barrantes-Vidal 2004).

Since the 1960s, psychological, psychiatric and biological scientists, as well as philosophers, writers and journalists, have been investigating and commenting on this (often anecdotally) observed connection. Eissler (1967, 1971) and Gedo (1972) seemed fascinated by assumed links between creativity, genius and psychopathology. Another psychoanalytical author of the period, Noy (1984: 421), focused on the role of originality of thought as a personality trait and its particular association with both the creative process and that of psychopathology. By the later 1980s and into the 1990s, medics were delving into the psychology of some inventive scientists, artists and literati of yesteryear such as Einstein, Turner and Virginia Woolf. Hare (1987) concluded that the evidence suggests a tendency towards a cyclothymic (‘bi-polar’) constitution. Yet when Post (1994) reviewed biographies of 291 living creatives with backgrounds in science, politics, philosophy and the arts and assessed them on DSM III criteria (APA 1994), there was scant evidence for psychotic illness prevalence outside of the norm. He did find, though, a predominance of mood problems, especially depression, as well as addictions and ‘minor neurotic abnormalities’. These latter findings are similar to those from a retrospective psychiatric investigation of former famous jazz musicians, carried out in the early 2000s, however the author points out ‘serious flaws’ in the reasoning behind such correlation-based methods. There is no way of determining the direction of cause and effect in correlational studies. That is to say that given the possible emotional and financial insecurity of a freelance arts profession and the various social contexts to be negotiated, ‘life as a jazz musician might actually cause mental disorder’ (Poole 2003: 194).

More authors are producing texts that draw from developments in cognitive science, a science towards which there has been an explosion of attention in recent decades. Taking inspiration from the expanse of new knowledge in neurobiology, neuro-anthropology and in the lifelong plasticity of the brain (Castillo 1998; Kolb and Whishaw 1998), writings explore creativity and mental health in terms of particular modes and networks of perception, thought and emotion (Prentky 2001). These capacities for perceiving, thinking and feeling are shaped by environmental conditions and also vary across individual physiology and psychology, affecting individual interpretations of the outside world and inner experience. This variation of individual temperaments embedded in social and cultural contexts is the process through which the unique individual lifeworld is created and the personal embodied subjectivity of the self is maintained and indeed transformed at regular junctures.

It also brings to light the strong impact of environment and culture on self-experience (Benedict 1935; Cole 1996) with that self being noted to be a relational subject within a social milieu, or as Strathern puts it a ‘-dividual’ (Strathern 1992). Further work on the social and historical forces shaping mental health experiences and social attitudes is found in Saris (2000) and Cochrane (1983). A cultural–historical approach also takes into account the ways in which these processes have helped to construct stereotypes of the mentally ill, including notions of the melancholy, romantic poet as well as the supposed mad genius (Becker 2001).

Biology, culture and mental health

More clinically orientated authors have taken the epidemiological evidence that a set of observed behaviours and expressed experiences, currently termed ‘schizophrenia’, tends to run in families and used that observation to suggest an at least partial, yet complex genetic origin for the condition (Kendler 2004; Riley and Kendler 2006). Others go on to speculate that the closeness of these gene regions to other regions thought to be linked with creativity might explain the assumed association between creativity and mental disorder (Barrantes-Vidal 2004). Overall, the search for ‘the holy grail’ of a ‘phenotype for schizophrenia’ continues (Andreason 2000: 108). Researchers have taken advantage of today’s in-depth mapping of the human genome to strengthen the proposal that creativity and susceptibility to mental illness might be coded into similar genetic regions or even specific genes. This search for a clear genetic base for mental illnesses, particularly schizophrenia, has brought forth countless papers over recent decades describing family case studies (Bassett et al. 1988), and more extensive population genetics studies (Kendler 2004; Riley and Kendler 2006), but at best has settled on a concept known as the ‘schizophrenia vulnerability locus’. That said, other work has suggested that impaired cognitive functioning may be affected by the dampening influence of the COMT gene on prefrontal cognitive functioning and dopamine activity (Malhotra et al. 2002).

Further studies have been inconclusive however, or even contradictory, especially in relation to any link between the COMT gene and schizophrenia (Munafo et al. 2005). Given the maxim, also, that ‘correlation does not prove cause’, and with new insights from epigenetics into the complexity of genotype-phenotype relations, modulated by enzymes and by other environmental factors (Egger et al. 2004), it might be postulated that following a pathway to isolate single genes (or single causative factors for that matter) and relating them to single outcomes, such as supposedly clear cut mental illnesses, or unspecified notions of ‘creativity’, represents something of a blind alley.

From a health perspective, notwithstanding some aggressively expressed conditions such as Huntington’s Chorea, Cystic Fibrosis, various special needs syndromes and particular forms of cancer, genetic loads in humans are recognised nowadays by human biologists to exert their effects only as part of a complex co-influence with other groups of genes and in response to particular features of the surrounding environment, including experience (Plomin 1989; Hinwood 1993: 274–276; Egger 2004). Genetic inheritance is, therefore, in many situations, not a deterministic influence but merely a biological potential (Gould 1977, 1984). Cancer genes operate this way (Tortora and Grabowski 2000: 97), even more so genes that influence psychological capacities, mental illness vulnerability or a tendency for ‘extreme experience’ (Littlewood 1993; Castillo 1998). Social and cultural forces have long been noted to shape psychology and to influence the ways in which psychological experiences are interpreted and responded to, a phenomenon known as social labelling theory when applied to the categorisation of mental illness (Scheff 1975; Cochrane 1983).

Utilising the term ‘bio-social dialectic’, the unlabeled, undifferentiated potential for ‘extreme experience’ or ‘extreme cognition’ has been investigated extensively by biologists and anthropologists, who have demonstrated that human bio-psychology is heavily shaped by social environments and understood through dense cultural codes. Our very evolution as a species has been driven by culture, ever since the capacity for social learning emerged (Montagu 1962; Lewin and Foley 2004: 458–459; Park 2005: 87–91). Culture in the anthropological sense is neatly summarised in the following definition, ‘that huge proportion of human knowledge and ways of doing things that is acquired, learned and constructed, that is, not innate to the newborn child’ (Rapport and Overing 2000: 92–93).

Applied to interpretations of psycho-social experience, this awareness of the cultural dimension makes it clear that mental illness as a culturally constructed category is not quite so clear cut as we have been led to believe. One professor of anthropology and psychiatry at UCL advises that ‘we can never have psychological representations of brain states independent of social experience and action, for the notion of a culturally unfettered nature is a fiction’ (Littlewood 1993: 216–217). Another psychiatry-anthropology professor, this time at Harvard, drew from his work among sufferers of chronic health conditions including asthma, pain and depression in both America and China, to show that suffering as a ubiquitous human experience produces meaning. Meaning is at the core of human experience. Like all other experiences, illness contains both sensation and interpretation and is therefore at once biologically, emotionally, cognitively and culturally shaped and responded to (Kleinman 1980, 1988). Likewise then, recovery.

Lived experience and making meaning

It has been argued that individual experience is in some ways an interpreted phenomenon and its assessment as good or bad, pleasant or unpleasant, normal or abnormal, depends on a multitude of factors, including individual tendencies, past learning and cultural mores. From an existentialist-phenomenological and cultural relativist view, it can be appreciated that what seems strange in one context or mindset might be welcomed in another; and a sensation that distresses one person might excite or motivate another. Again it is useful to turn to anthropology for an understanding of this interpretive side to human life. Ruth Benedict coined the concept of a ‘universal arc of human potential’ out of which specific groups carved their distinctive ‘patterns of culture’ by elaborating certain segments of that arc in creative and novel ways. In Patterns of Culture, Benedict explained that a young Crow man, who was disinclined towards the culturally expected characteristics of warrior-hood of his tribe, would be considered dysfunctional or deviant. Yet, she reflected, among the Shasta of California, for instance, ‘he might have been a shaman’ (Benedict 1935: 187).

Though a range of ‘extreme experiences’ can be identified ethnographically (Littlewood 1993: 17), the extent to which this is interpreted as madness or inspiration is, to some extent at least, culturally determined (Castillo 1998). Skills in reining in behaviour to resonate with culturally viable themes have been shown to shape any resulting social category. For example, a voice hearer might be deemed a medium or a prophet and elevated to figurehead status in a New Guinean village (Whitehouse 1996). Another interesting situation is described wherein Simon, an African American man, articulated his extreme cognitive experiences through the religious frame of ‘bibliomancy’. By allowing candle wax to drip onto an open Bible, Simon found inspiration and support and was able to engage constructively in his personal and occupational life. Through this and other behaviours he would have conceivably fitted certain diagnostic criteria according to DSM-IV (APA 1994), yet as researchers observed, Simon had ‘high self-esteem, firm moral convictions and a strong sense of purpose in his life. His beliefs were, then, essentially affirming [and] increased rather than detracted from his ability to function effectively’ (Jackson and Fulford 1997: 46).

Existentialist psychology

With due respect to all the disciplines who contribute to the knowledge base on culture, creativity and the existential-phenomenology of mental health, the philosophers might be allowed to have the definitive word, not least because of the way in which the particular philosophy of existentialism has come to underpin a growing trend for socio-dynamic constructivism and personal creativity in the fields of counselling, psychotherapy and positive psychology (Schneider and May 1995; Peavy 2006; McCleod 2008; Maisel 2012a&b; Thomas and Bracken 2012). Existentialist guru Jean-Paul Sartre rejected any form of totalisation of thought on mental health and claimed that

one cannot understand psychological disturbances from the outside, on the basis of a positivistic determinism, or reconstruct them with a combination of concepts that remain outside the illness as lived and experienced.

(Sartre 1963 in Laing and Cooper 1964: 6; italics original)

Lived experience then must be a central tenet for any exploration and evaluation if the phenomenological-existentialist approach is adopted. It is certainly one of the underlying influences on the current and recent empirical literature and seems to have been heavily endorsed by service users themselves, if not overtly then at least as a subtle, underlying assumption. Professionals and academics are following this lead from service users to develop clinical and community care evaluation programmes that utilise lived experience as both a method and an outcome. Yet theoretically, an existentialist-phenomenological approach is not new and could be said to have had a certain heyday during the growth of ‘alternative psychiatry’ and the therapeutic community movement in the 1960s and 70s. This phenomenological psychiatry of Dr R.D. Laing (bolstered by his work with colleagues in The Philadelphia Association) really began with the publication in 1961 of The Divided Self, followed in 1967 by The Politics of Experience, in which Laing laid out his views on an existentialist-phenomenological basis for mental illness, especially psychosis. It was, he argued, an understandable defence mechanism invoked in the face of often very obviously intolerable social conditions.

Laing never adhered to the label of ‘anti-psychiatry’, indeed he worked tirelessly as a psychiatrist for a more humane and theoretically expansive discipline of psychiatric medicine. But his work did bring to light some of the negative effects of a diagnostic label and the perhaps unintentional negative aspects of physical treatments, especially ECT, lobotomy and insulin coma regimes (Browne 2008). Laing did also implicate certain types of family relationships and interpersonal attitudes and styles of communicating, as well as wider social forces that he thought denied the self and alienated the person, and all of which seemed to correlate with a higher risk for psychotic breakdown, in young people especially. These conditions were deeply damaging to the psyche in Laing’s view. His claims, unsurprisingly, invited much criticism and debate but this was well matched and for a time overridden by the praise, admiration and following for his ideas as well as his charismatic person.

This book does not seek to delve into arguments on Laingian views and practices but for our purposes it is suffice to say that Laing’s work pre-empted today’s burgeoning existentialist and humanistic psychology and as such he broke new ground in a number of ways:

• Laing was determined to understand the suffering person from that person’s experience of the world, over and above any attention to diagnosis.

• Laing’s work recognised the deep impact of social relationships and a sense of social support on psychological health and well-being.

• He helped to sow the seeds that should eventually de-stigmatise mental illness by dislodging the notion of a vacuum-sealed illness and replacing it with a sense of the socially embedded self.

• His practice was based on empathy and co-presence rather than any power-infused knowledge base and expert title.

• Experimental research, initiated by Laing in his early clinical career, was one of the first in recent centuries to adopt an environmental perspective on improving the lived experience and well-being of psychiatric patients (Cameron et al. 1955).

The Philadelphia Association was a movement of like-minded practitioners, including Laing, who set up community houses to provide support and what they saw as social treatment options for people suffering various forms of mental distress. The culture was one where distinctions between staff and residents were minimised and kindness, understanding, responsibility and freedom of expression were the underlying principles. It was believed and hoped that this would foster the ‘healing journey’ and that people would make a better and more long lasting recovery away from the side effects and iatrogenic effects of standard psychiatric treatment and hospitalisation. In an enlightening, often heartening but sometimes heartbreaking biography of his father, Adrian Laing gives a detailed description of one of the community houses, perhaps the most famous one, Kingsley Hall in London’s East End (Laing A. 2006: 93–105). The establishment was not without high drama and recurrent tensions often broke through. Yet there were successful recoveries forged in this counter-cultural ‘happening’. One of the most famous is that of Mary Barnes, who worked closely with Laing’s colleague Dr Joseph Berke and eventually became a celebrated artist herself (Berke and Barnes 1990).

Before moving on to explore the shift towards creative activity as an adjunct in mental health treatment and care, it is important to summarise the legacy of R. D. Laing as it has never gone away and will no doubt achieve greater recognition as humanistic and existentialist mental health practice develops. One of Laing’s greatest attributes was his empathic rapport with suffering people, often able to elicit ventilation of thoughts and feelings from individuals who were otherwise and with all other persons completely uncommunicative. Coupled with a conscientious drive towards authenticity and truth, we might remember these words, ‘We need to draw on our inner Laing from time to time and exclaim “No, this is not right” ‘ (David 2006).

As Laing and colleagues spread their influence, though perhaps somewhat idealistic at the outset, Kingsley Hall and other therapeutic communities, such as those endorsed by Maxwell Jones (1968) and more recently in Northern Ireland The Richmond Fellowship (Kapur 1997), opened up an awareness of the possibility that freedom of expression and a climate of creativity in a somewhat democratic and supportive social environment could facilitate a healing process. Something of a turning point can be detected here. Not only was mental distress seen to be associated with creative responses to an ‘insane world’, but expressive avenues for these experiences were held up as central to their model of mental health support. It did not work for everybody, though. While disturbed and disturbing behaviour was certainly accommodated to a greater extent in these community facilities, some residents experienced fear and unpredictability, as revealed in Clancy Segal’s novel Zone of the Interior, widely regarded as a thinly veiled factual report (Segal 2005). In the conclusion of this book there will be some discussion of areas that need to be explored such as how and why individuals might be included or excluded from creativity and social support settings and the fate of services users who are unable or unwilling to participate in socially situated activities. That said, from the shifts in ideas on mental health and illness that originated in the 1960s and into the 70s, creativity and men...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Preface: The Story of This Book
• Acknowledgements
• Introduction: The Current State of Play
• Part I: Ideas and Evaluation in Creativity and Social Support
• Part II: Modes and Meanings in Service Users’ Experience
• Conclusions and Recommendations for Policy and Practice
• Bibliography
• Index