On Schizophrenic Poetry

To cite this Article: Bakare, Muideen Owolabi 'Morbid and Insight Poetry: A Glimpse at Schizophrenia through the Window of Poetry', Journal of Creativity in Mental Health, 4:3, 217 - 224

Abstract

Creativity, language, and psychotic disorders may share a common neurological and evolutionary background. These processes are uniquely human and may converge in poetic expression that illuminates the inner world of patients suffering from schizophrenia. Two types of poetry that may be written by patients with schizophrenia are identified as morbid and insight poetry. Clinicians are urged to pay attention to the writings of their patients and encourage them to document the experiences of their illness. Writing may help patients gain an in-depth insight into their own inner world and the nature of their illness. Poetry may also help clinicians understand the peculiar individual psychodynamics of their patients' illness.

Keywords: morbid; insight; poetry; language; psychosis; schizophrenia; creativity

Introduction

Individuals with mental health disorders may experience heightened creativity during the course of their illness (Andreasen, 1987; Buck & Kramer, 1977; Claman, 2001; Rihmer, Gonda, & Rihmer, 2006). Patients with schizophrenia, for example, may find an expressive outlet through writing poetry (Buck & Kramer; Miliavskii, 1981; von Keyserlingk, 1978; Zapotoczky, 2005). As individuals with schizophrenia cope with various phases of their condition, the quality of their behaviors and interactions may vary considerably. As such, a particular interest was sparked in exploring the poetic expression of individuals with schizophrenia during periods of remission and active phases of their disorder. From interactions with patients with schizophrenia as they constructed their poetry, and reviews of their work, two broad categories of poetry were identified. Morbid poetry is poetry written while the individual with schizophrenia is experiencing the worst of the disease. Conversely, insight poetry is our term for schizophrenic poetic expression while individuals are lucid and in remission. It is suggested that practitioners can assess the mental well-being of individuals with schizophrenia by analyzing the language and quality of their poems. This can be helpful for clinicians to understand the mental processes of their clients with schizophrenia.

SCHIZOPHRENIA AND ITS ETIOLOGY CONTROVERSY

  Gelder, Gath, Mayou, and Cowen (1996) suggest that schizophrenia is a complex disorder and may be the result of a constellation of brain dysfunctions instead of a single diagnosis as presently classified in modern classifications such as the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization [WHO], 2007) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000). However, a recent argument suggesting schizophrenia and other psychotic disorders might originate from a single gene located in a specific region of the brain associated with language development is worth attention (Berlim, Mattevi, Belmonte-de-Abreu, & Crow, 2003; Crow, 1997, 2000). For this recent argument to be fully applicable, presumption of a theory of unitary psychosis with severity continuum needs to be made.

LANGUAGE, POETRY, AND PSYCHOSIS

  Poetry allows access to the inner life, thought process, and emotions of the writer. Poetry can serve as an outlet for emotional expression and description of experience, or it can expand into surrealism. Surrealistic poetry may read like the thought processes and experiences of those suffering from schizophrenia (Al'tima, 1995; Graves & Schermer, 1998; Lombardo, 2007; Powell, 1998; Rhodes, Dowker, & Claridge, 1995; Zapotoczky, 2005). Therefore, it is not surprising that poem writing has been noted as a common phenomenon in patients with schizophrenia and other psychotic disorders (Buck & Kramer, 1997; Miliavskii, 1981; von Keyserlingk, 1978; Zapotoczky). The assertion that schizophrenia and language development may be tied together genetically (Crow, 2008) may explain why schizophrenia perpetuates despite its reproductive disadvantage. Crow's work on the genetics of language and psychosis may also explain the associations between schizophrenia, other psychotic disorders, and poetry as a function of brain development and heredity.

MORBID POETRY AND SCHIZOPHRENIA

  Part of the criteria for making diagnosis of schizophrenia is the presence of functional thought disorders (Gelder et al., 1996), which can be revealed in verbal and written expressions. Poems of individuals with schizophrenia during their defective cognitive states can offer a great insight into their thought processes and emotions. Specifically, poetry writing during a morbid state could reveal a peculiar play with words, loosening of associations, derailment of thought, and formation of new words (i.e., neologisms). Holistically, morbid poetry may also offer insight into the delusional themes expressed by patients in their writing. Clinically, Miliavskii (1981) suggested that verses of patients written in the active phase of their schizophrenia could serve as a differential diagnostic tool, helping clinicians assess the severity of the disorder.

Case Illustration of Morbid Poetry

  R is a 44-year-old male with a diagnosis of schizophrenia who was in treatment at Federal Neuro-psychiatric Hospital, New Haven, Enugu, Enugu State, Nigeria. R wrote several poems, and two of his poems that seemed to be the best examples of his variable cognitive states were analyzed. The first was written when he was acutely ill and mentally unstable. The second was written when he began his recovery from the acute episode of his psychotic illness. Reproduced below is the first poem, titled, “Accord is Dead,” written in his acute morbid state:

Vanity fair
Of mythology and superstition
Of the moon and stars
Land and sea, sun and sea
Hollandis
Victory boogie woogie by mondriaan
Van Gogh, the sky over Holland
Waterloo plein temple of Budda
China world focus
Of the cross, the soul and of the heart
The loop baan mode, Greek specialiteiten
Paradiso, Hotel Old Dutch
P& T, PTT, No limit records
Oya! Ali baba of turkey? Ali baba of Lebanon?
Camel lights, tiger by the tail
It is Ali again in Venice
Vlisso textites
Familiar variety, caballero
Vlissingen, time will tell
Drummer! Kofi the drummer boy
Drumboy in Africa
Pakistan Linking - Hugo Boss woman
Air freshener misdefined by commission
Hugo Boss Number one of Chavez by Fidel
Acapulco, Mexico after dark
Jonas had a Gucci
London-Paris-Newyork, Cuba-Mexico-Brazil
OBJ with the queen
Some one called the white house
Metropole by night, kingsize
Antwerp, united we stand
How many licks?
Ecstacy the summary

Using the poem as a clinical tool, I found it lacked a key point other than the attempt at citing different regions of the world. Also, there was a peculiar play on words, which was curious and seemed to suggest some comprehensibleness to this poem. There was an obvious loosening of associations and formation of new words. The observation in this poem is consistent with the recommendations of Miliavskii (1981) to use poetry as a diagnostic tool. There were also markers in this poem consistent with some of the diagnostic criteria needed to make a diagnosis of schizophrenia (APA, 2000; WHO, 2007).
The second poem, titled “Accord Concordiel,” was written by the same patient during a more stable mental state:

Above the drumbeats of china
Above the decayed ruins of Egypt
To the world we left behind
Adam and Eve
To a new world order
The C.I.S
To structure and adjust the new era
Robert Mugabe and the white farmers of Zimbabwe
Definite and absolute
The state of independence must be
The rewards and gains of desirable labor becomes state of affair
Of a common interest and general perspective
The right of individuals becomes the rule of law
For all we are and have
Rules of expectation and achievement become unchanged

A close examination of this work in relation to the first poem revealed a lesser degree of play on words, neologisms, and loosening of associations. There appeared to be a definitive goal to which the patient was alluding, possibly a unified world and an egalitarian society. This particular poem seemed to have more meaning when compared to the first poem. Despite this poetry showing some stable thought patterns, I still considered this poem as morbid. Morbid poetry may be assessed along a continuum, with some poems expressing severe surrealistic qualities, while others may display a mix of rational thought and defective thought process. Other researchers have explored how poetry may be a clinical lens for understanding a patient with schizophrenia (Maia & Jorge, 2001).

Clinical Significance of Morbid Poetry

  One clinical advantage of assessing morbid poetry at different stages of a psychotic illness is that it can help assess psychopathology and mental state of the patient. Analysis of the written text may help confirm a diagnosis. It can also help assess a patient's response to treatment by illustrating the differences in coherence and thinking. This was evidenced in the previous poems written at different intervals of the patient's illness. These written works may help clinicians determine when an individual with schizophrenia is at the brink of a lapse into psychotic thinking.

INSIGHT POETRY AND SCHIZOPHRENIA

  When individuals with schizophrenia experience lucid and coherent cognitive states, they may also express themselves poetically. This particular kind of poetry is often found in patients who have insight into the nature of their illness. Insight poetry often incorporates some features of psychodynamic psychotherapy (Wallach, 2005) and cognitive behavioral therapy (Tolton, 2004) to bring about the process of healing, recovery, and adaptation in the affected patients. Therefore, while insight poetry may also serve as a diagnostic tool, this kind of written expression may have therapeutic advantages as well.

Case Illustration of Insight Poetry

  The healing process of insight poetry written by people who suffer from mental disorders associated with psychotic symptoms is well documented (Hayashi, 1998; Powell, 1998; Tolton, 2004). Tolton shared a first-person account of how insight poetry helped him walk through his illness. Taken from his work are two poems partly reproduced below as illustration:

Psychosis
Your delusive way of thinking
Makes you behave eccentrically
And you just don't know you're poorly
Hypersensitivity (Tolton, p. 472)

The above poem showed some element of cognitive restructuring and behavioral modification. It also showed a change in perception of situation as documented in Tolton's account of “How I saw my illness” and “How I see my illness” (Tolton, 2004). Reproduced in part below is another poem in the first-person account of Tolton.

Psychosis, Disturbed Thoughts, Light and Hope
That thought was delusion
I've nipped it in the bud
I can recognize thought rubbish
And split factual from the dud (p. 472)

The above poem also showed some cognition restructuring. The author wrote about recognizing signs of his illness and revealed his ability to differentiate between reality and delusional fantasy.

Clinical Significance of Insight Poetry

Insight poetry may serve several clinical purposes. First, this kind of writing may help clinicians assess patients' recovery by highlighting self-awareness and cognitive changes. It could also help patients understand their inner world and work as a potential coping mechanism by allowing patients to document their change and relevant struggles. By paying attention to the poetic expression of their patients, clinicians can use this tool to better empathize with and relate to their patients' experiences. As clinicians begin to know the subtle nuances of a patient's expression, they can become attuned to changes in the poetry and respond therapeutically. Previous insight poems may work as reminders for patients about their awareness and may be used as examples of therapeutic goals, especially after a relapse. In this way, each person may experience individualized, patient-centered care.

CONCLUSION

  Poetic expression offers patients and clinicians an outlet to explore and document the full range of emotional and cognitive expressions. As seen on a spectrum of healing and illness, morbid poetry represents a form of communication that illustrates the surrealistic quality of the schizophrenic mind. In light of the tie between language and psychotic disorders, morbid poetry may offer a glimpse into the ebb and flow of chronic psychosis. As individuals progress in treatment, their words may move from disorganization and chaos to self-reflection and healing. When this shift happens, a new form of expression, called insight poetry, emerges. While both insight poetry and morbid poetry can be used as assessment lenses, insight poetry offers patients their personalized story of healing. Schizophrenia and other psychotic disorders result in isolation and distress for affected individuals. Poetry is one outlet to help them express their world and connect with a helping professional. Professionals may find poetry helpful to gaining a deeper understanding of their patients' stories of illness and wellness.

REFERENCES

• 1. Al'tima, IaA (1995) The neuropsychological hypothesis of the mechanisms of poetic inspiration. Zh Vyssh Nerv Deiat Im I P Pavlova 45 , pp. 227-241.
• 2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders text rev 4th, Author , Washington, DC
• 3. Andreasen, N. C. (1987) Creativity and mental illness: Prevalence rates in writers and their first degree relatives. American Journal of Psychiatry 151 , pp. 1650-1656.
• 4. Berlim, M. T. , Mattevi, B. S. , Belmonte-de-Abreu, P. and Crow, T. J. (2003) The etiology of schizophrenia and the origin of language: Overview of a theory. Comprehensive Psychiatry 44 , pp. 7-14. [ csa ] [ crossref ]
• 5. Buck, L. A. and Kramer, A. (1977) Creative potential in schizophrenia. Psychiatry 40 , pp. 146-162.
• 6. Claman, H. N. (2001) Creativity and illness: Christopher Smart and Samuel Johnson. The Pharos 64:3 , pp. 4-7.
• 7. Crow, T. J. (1997) Is schizophrenia the price that Homo sapiens pays for language. Schizophrenia Research 28 , pp. 127-141. — ? [ crossref ] [ csa ]
• 8. Crow, T. J. (2000) Schizophrenia as the price that Homo sapiens pays for language: A resolution of the central paradox in the origin of the species. Brain Research Reviews 31 , pp. 118-129. [ crossref ]
• 9. Crow, T. J. (2008) The 'big bang' theory of the origin of psychosis and the faculty of language. Schizophrenia Research 102 , pp. 31-52. [ crossref ]
• 10. Gelder, M. , Gath, D. , Mayou, R. and Cowen, P. Gelder, M. , Gath, D. , Mayou, R. and Cowen, P. (eds) (1996) Schizophrenia and schizophrenia-like disorders. Oxford textbook of psychiatry pp. 246-293. 3rd, Oxford University Press , New York
• 11. Graves, M. and Schermer, V. L. (1998) The wounded male persona and the mysterious feminine in the poetry of James Wright: A study in the transformation of the self. Psychoanalytic Review 85 , pp. 849-869. [ csa ]
• 12. Hayashi, Y. (1998) The expressive psychopathology of the Japanese poet, Sakutaro Hagiwara. Psychiatry and Clinical Neurosciences 52 , pp. 621-627. [ crossref ] [ csa ]
• 13. Lombardo, G. T. (2007) An inquiry into the sources of poetic vision: Part I - The path to inspiration. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 35 , pp. 351-371.
• 14. Maia, R. M. and Jorge, M. S. (2001) Understanding the person with schizophrenia from the point of view of Merleau-Ponty. Revista Brasileira de Enfermagem 54 , pp. 558-567.
• 15. Miliavskii, V. M. (1981) Psychopathology of poetry writing of schizophrenic patients while ill. Zh Nevropatol Psikhiatr Im S S Korsakova 81:1 , pp. 104-108.
• 16. Powell, C. (1998) The nameless father in the poetry and life of Francis Webb. Australian and New Zealand Journal of Psychiatry 32 , pp. 488-495. [informaworld]
• 17. Rhodes, N. , Dowker, A. and Claridge, G. (1995) Subject matter and poetic devices in psychotics' poetry. British Journal of Medical Psychology 68:Pt. 4 , pp. 311-321.
• 18. Rihmer, Z. , Gonda, X. and Rihmer, A. (2006) Creativity and mental illness. Psychiatr Hung 21 , pp. 288-294.
• 19. Tolton, J. C. (2004) First person account: How insight poetry helped me to overcome my illness. Schizophrenia Bulletin 30 , pp. 469-472. [ csa ]
• 20. von Keyserlingk, H. (1978) Literary creations of schizophrenics. Psychiatr Neurol Med Psychol (Leipz) 30 , pp. 166-172.
• 21. Wallach, M. (2005) Listening to Oedipus: Two poems by sons about fathers. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 33:1 , pp. 191-206.
• 22. http://apps.who.int/classifications/apps/icd/icd10online/ — World Health Organization. (2007). International statistical classification of diseases and related health problems (10th rev.)
• 23. Zapotoczky, H. G. (2005) Poetry and schizophrenia. Fortschr Neurol Psychiatr 73:Suppl 1 , pp. 84-87.