Dante or the DSM*? Art and the re-imagining of ‘mental health’

Art can inspire and lead us in inventing new ways of expressing the unique nature of our experiences and in imagining our futures, beyond stale and imposed vocabulary, concepts, models and terminology.

According to Amnesty International, ‘a change in culture and attitudes is key to reform’^[i] in dealing with ‘mental health’. However, the term ‘mental health’ is reductive and somewhat misleading. Emotional and existential wellbeing are not simply medical matters of the mind but reflect every aspect of our lives. How we deal with these issues as a society can give us a valuable insight into our wider cultural and ideological principles. Instead of looking seriously at the economic, social, interpersonal and cultural reasons why and how we are driven mad, a medical and healthcare-focused discourse invites us to see our deep crises of existence as requiring a solely medical or healthcare-focused solution. I would argue that the solutions to existential and emotional distress lie not only in the realm of healthcare but on much deeper social, political and cultural levels. I believe it is artists, and particularly artists with personal experience of distress, who have the sharpest tools to excavate and illuminate these underlying factors and how they manifest in, and impact on, human consciousness.

While there are still many lingering popular misconceptions about ‘mental illness’, fuelled mainly by the continuing medical promotion of unproven hypotheses of biological and genetic causation, many influential voices within psychiatry have already admitted that no evidence to back up such theories has been found. As Arthur Kleinman, Professor of Psychiatry at Harvard  University, has written:

After decades of investment in biological psychiatric research, there are many intriguing and potentially significant findings, yet still not a single biological test that can be routinely used in the clinic to determine whether someone has a particular mental disorder. Brain science has advanced impressively for neurological conditions, and for our general knowledge of how the brain works, but it has not determined what causes schizophrenia, depressive disorder or anxiety diseases. […]This should count as an extraordinary failure […]^[ii]

Many of the assumptions and language underpinning our traditional understanding of ‘mental illness’ are now being challenged from both within and without medicine and science. After decades of research, science and medicine have reached a dead end in their search to prove their theories of biological and genetic causes of existential pain and distress and are still hell-bent on focusing on what we don’t yet know. Artists have been focusing with laser precision for centuries on what we do know, that we are driven mad by traumas of living, broken dreams, the death and excesses of love, ‘man’s inhumanity to man’,^[iii] the terrors of human existence and consciousness. These philosophical and emotional conundrums of the human condition are the terrain of art, not medicine, of Dante, not the DSM.

Central to this seismic shift in thinking, and its public dissemination, is the role played by those who have experienced distress and (often distressing) treatment first-hand and, in doing so, have become experts in the field. Many of these experts by experience have developed concrete proposals and alternatives based on autonomy and creativity which put their experience, knowledge, interpretation and narrative at the heart and at the forefront of any model of recovery or – as I prefer to call it – transformation (‘recovery’ as a concept having been increasingly hijacked and diluted). As these ideas gain increasing currency, I believe it is art that has the unique capacity to communicate and explore these alternative narratives and their implications. A medicalised language to explain crises of the human condition has failed. Art can inspire and lead us in inventing new ways of expressing the unique nature of our experiences and in imagining our futures, beyond stale and imposed vocabulary, concepts, models and terminology.

There are also a great number of artists who suffered brutality at the hands of the psychiatric system, Antonin Artaud being one of the most prominent examples, but many others too including the musicians Peter Green and Roky Erickson, to name just three who have influenced my own work. Artistic expression has been fundamental to the survival of a great number of patients of psychiatric institutions in the twentieth century (perhaps exemplified most startlingly by the Prinzhorn Collection of asylum-patient art in Heidelberg) and to many others outside the psychiatric system. The psychologist and academic Gail Hornstein, author of the fascinating book Agnes’s Jacket, ^[iv] has mapped the little-known and suppressed canon of first-person literary accounts of madness and her bibliography now runs to hundreds of titles.^[v] The corresponding hidden histories of theatre, music and dance have yet to be mapped but what is clear is this: that art and art-making have been fundamental to finding new ways of articulating acute meltdowns of consciousness. This art has conveyed deep messages to society about the causes and complexity of distress at times when society has chosen to firmly block its eyes and ears.

There are deep historical links between the arts and therapeutic disciplines. These links reached their peak in the early twentieth century with the advent of modernism when it looked like the fields of psychology, psychoanalysis and radical art practices were moving closer together, each informing the other, particularly in the case of Surrealism. These innovations diminished as the field became increasingly dominated by pharmacology and the pharmaceutical industry. With the cracks in this paradigm being prised apart ever wider, and with an increasing demand for an appreciation of narrative and representation as a means of understanding human experience, I believe a space is re-opening to establish a fresh dialogue between art and the field of ‘mental health’. This would look to art not merely as therapy, or as an addition to treatment, but as a radical and guiding force to help us re-imagine, re-formulate and liberate our understanding of existential pain. All transformation begins in an act of imagination.

Dylan Tighe is a musician, actor and theatre-maker with experience of distress and psychiatric treatment. His radio drama for RTE? ‘Record’, challenging a bio-medical view of mental distress, was nominated for the Prix Europa Radio Prize (http://www.rte.ie/drama/radio/plays/what-is-life/2013/0424/647395-specials-science-recordbydylantighe/). His debut album of the same name, inspired by his own experience, was released to acclaim in 2014 (www.dylantighe.bandcamp.com). He has recently contributed a chapter entitled ‘Start Making Sense’ to Performance, Madness and Psychiatry, published by Palgrave. A new album will be released in 2016.

An earlier version of this piece appeared in Issue 71 of Inside Out, The Journal of the Irish Association of Humanistic and Integrative Psychotherapy.