Abstract

             The relationship between madness and genius fascinates the lay person and expert alike. Most geniuses are not mad and madness doesn’t guarantee creativity. Creative individuals may be of insane temperament, their insanity traits hinder creativity.

Confusion regarding the difference is not surprising when one considers that a mad person has lost contact with reality, while a genius presents a new and unusual view of reality.

Before the genius has been accepted by society, he may appear mad.

My study of Vincent van Gogh should clarify this distinction. Vincent van Gogh suffered from mental illness but never lost touch with reality which is manifested in his letters and art. I analyzed Vincent from a sociological, religious and psycho-developmental perspective and came to a conclusion that his works were produced by an inner necessity and his creativity gave him during the time of illness a sense of wholeness, self-expansion and growth.

Introduction

            The Greeks spoke of the search for the principle of the “Good Life”. The Romans had a phrase, “Mens sana in corore sano.” Psychoanalysts today talk about an integrated “Ego.” For ages, men and women have been seeking a style of life and spirit that achieves a wholeness, an integration, an authenticity of mind, body, soul, reason, passion, and desire. These days, the search is left to psychologists, therapists, and the religious to holistically and spiritually integrate the body.

Researchers avoided the subject of creativity because they perceived it as unscientific, mysterious, disturbing and too corruptive for the scientific training of graduate students. Today, researchers are focusing on the concept that creativity and healing, once fugitive and ubiquitous, are the marks of human nature, itself.

Whether in business, the arts, politics or personal relationships, creativity involves “going beyond the information given” to create something authentic in the world. When the mind exercises the creative muscle, it also generates a sense of well-being, pleasure, joy and ecstasy. Feelings can include frustration, fear, anxiety or despair.

Authentic art can create a war against oneself and one can become the vessel where the force goes through, and that feeling can be the closest in experience to a spiritual encounter. The creative experience can be quiet or full of wonder, but whatever the specific sensation, creativity carries with it a powerful sense of the mind working at the peak of its ability.

           In analyzing Vincent van Gogh’s art, I had an opportunity to transform myself from being symbolically impoverished towards a meaningful connection to the man: his traits, generic attitudes, experiences, struggles, ecstasies and torments.

          What do stars, sun, trees, clouds, fields, sowers and reapers mean? Should it signify anything? Vincent’s art work came out of a struggle to be helpless or helpful. He overcame the struggle by engaging his internal force to a canvas and set his spirits free. He experienced the pain of poverty and was able to communicate symbolically his feeling. The authentic expression freed him from the constraints which were psychologically with him. The creative process allowed his psyche to heal and restore him to wholeness. This ongoing process fostered personal growth and gave him a greater understanding to his inner self and his environment.

          His letters to Theo, his brother, revealed that healing through the creative process is possible. Images came from the depth of his psyche and he trusted them. His inner wisdom was his guide and his creative source. When faced with conflict, he allowed himself to go to the abyss. The unknown was painful and dangerous to him, but he faced it successfully and transformed himself spiritually. When he created he found the inner peace, the intangibles which a materialistic world could not provide.

          Vincent felt responsible for his disease and during various hospitalizations he gave ease to other people. Disease must have something constructive about it. Out of this struggle came the capacity to sense his own vulnerability and his ability to relate with the less fortunate. He became an instrument of healing.

          On his pilgrimage towards wholeness, Vincent’s clarity of vision and truthfulness to nature on canvas contain symbols that bring us in contact with our spirituality and could work as a healing agent. Vincent’s spirituality provided a sense of meaning and purpose to life, a connection to the transcendent and a connectedness to other sojourners who accompany one on life’s journey.

In this turbulent journey, these spiritual qualities fortified Vincent to survive the ravages of his disease. In expressing his feeling, he found the meaning in the chronic nature of his illness, learned to appreciate the gift of health and found strength to come back time and again from the pits of depression to the seductive highs of mania. The unconditional love provided by Theo empowered Vincent to hang tough and to accept medical intervention. His creativity served as a safety rope that kept him from drowning in the black waters of the depression.

          Vincent was never medically intervened and research indicates that the medical course of bi-polar disease worsens over time (the attacks become more frequent and more severe) and choosing death over life was Vincent’s flight from extreme despair, turmoil, and psychosis.

          Vincent’s art reveals the journey of a man who took an inward ascent and found divine order within himself. He achieved his ascent through scrupulous spiritual discipline. He trained himself to concentrate exclusively on contemplation, prayer, inner silence and never permitted himself to be distracted by idle thoughts and day dreaming. He achieved complete self mastery through voluntary suffering. This self training gave him inner power and purity which provided the psychic strength that brought him closer to the divine light.

          He established permanent contact with the higher self, or at least the ability to concentrate when necessary. He expressed beauty, as well as truth and goodness, because these qualities were reflected in everything he did, just as the presence of light dispelled shadows.

          The law governing the effect of light on darkness applies equally to the spiritual and to the physical world. It is the same law with two aspects, one visible, and sensory, the other invisible and psychic. He painted this principle to illustrate the invisible in terms of the visible. For example, the absence of shadow indicates a luminous world where God is present and therefore there can be no outside source of light. The beings depicted are themselves sources of light.

          Vincent’s philosophy was the idea that the world was created by the entry of spirit into matter, and that light was primarily spiritual. He understood that its component elements are color. Knowing that the law of spirit and matter operates at all levels, he demonstrated by his use of color the descent of the divine spirit into the world of humanity. His art is a physical celebration of the divine manifestation, both in the cosmos and in himself.

         Whatever possessed Vincent to shoot himself (whether it was the fear of the ravaging torments of his disease, or a fit of anxiety after hearing troubling news from Theo, the brother on whom he was both so financially and emotionally dependent), he was obviously not the ceaselessly tormented genius he is still sometimes portrayed as being. In analyzing his work during his hospitalization, his art showed no signs of pathology and a few weeks before he committed suicide his sister-in-law described him as a broad-shouldered man with a healthy color, a smile on his face and a resolute appearance. This is confirmed by Vincent’s letter to Theo, “I still love art and life very much indeed.”

Vincent’s art, his nachlass has triumphed. His art became a bread and wine that everyone could share, he took his faith in the salt of the earth and transformed it into his gospel and exposed feelings and emotions in such way that they cannot be ignored, rationalized, or erased.

I will explore van Gogh’s art from a personal, clinical and psycho analytical perspective. Further, the importance of the art process as an interplay between the developing esthetic formal properties of the artwork and the artist’s association to it, conscious or unconscious will be stressed. I will include the issues of Vincent’s aesthetic ordering to his content and the rescues from the threat of unknown and predictable chaos. Also, I will explain the importance of unity, form and content with the integration of inner and outer experiences.

The relationships between artist and environment, and between reality and canvas are richly convoluted and layered into ambiguities. I will explore some of these layers in treating Vincent as a patient.

Personal History

Vincent was born on the 30 March 1853, at Zundert, a small village in Brabant, Holland. His father, Theodore, the village pastor, came from a pastor’s family of twelve children. Three of .Vincent’s uncles were picture-dealers and one of them, also called Vincent, owned a business at The Hague.

Theodore and his wife, Anna Cornelia, had seven children, four sons, Vincent, Vincent, Theo and Cornelius and three daughters, Anna, Elisabeth and Wilhelmina. The first born son, called Vincent, was stillborn. The family was a united one, where the domestic virtues and religion were the foundation of society. The van Gogh’s were middle-class citizens living in a narrow and restrictive Calvinistic austerity that did not tolerate any emergence of deviant behavior. Vincent was extremely sensitive and his earliest years profoundly influenced his character.

Clinical History

Vincent mastered elementary school. When he was 15 years old, Vincent suffered his first bout of melancholia and became increasingly hard to manage. After abruptly leaving high school, his home atmosphere became tense, anxious, full of fears and prohibitions. After high school, Vincent spent years in Brussels (The Hague), London, Amsterdam, Etten (The Borinage), Paris and later the region of southern France.

          In his earlier years, Vincent’s behavior grew pathological. He showed signs of erratic outbursts, developed night terrors, had hallucinations and encountered a personal crisis of faith. He neglected his body, looked emaciated, slept on clay floors in defecated buildings, was unkempt, unshaven and verbally abusive. At home again, he rejected all authority, started to paint and maintained a log containing letters to his brother Theo. His personality deteriorated rapidly. Hs first major crisis, which required hospitalization, was the onset of the down spiraling disease of insanity. His suicide at the age of 37 ended the torment of emotional euphoria, hyperactivity, insomnia, flight of ideas, hyper sexuality and extreme sadness and despair.

Development - Perspectives of Van Gogh

Cain and Cain (1964) indicate that Vincent asked himself frequently the question: Who am I and where shall I go? Letters to his brother Theo reveal how deeply this question affected him. To understand his questioning, one has to focus on the unusual circumstances affecting van Gogh’s infancy.

One year to the day before van Gogh was born, his mother gave birth to a stillborn child, named Vincent. Van Gogh’s mother’s grief was intense when Vincent was conceived and born. Even though she was happy at his birth, she proudly acclaimed that Vincent was an excellent replacement for his departed brother. Some chronologies include in the family book of birth the words: “The Eldest Surviving Son.”

Sabbadini (vol. 32) believes that the word “Surviving” is the key to an initial understanding of Vincent’s inability to live easily with himself or others. Vincent could only attain the perfection of his brother’s unrealized life by suffering and ultimately dying—a prospect made particularly vivid by the presence of the other Vincent’s tombstone. The first Vincent was buried in the graveyard of the church where his father was pastor. The second Vincent, our Vincent, saw this tombstone with his name on at least once a week and perhaps more than that, since he spent his formative years just around the corner from that graveyard. So, the question which haunted him for his short life arose: Who am I? Does my life belong to another?

              Lubin’s (1972) research indicates that Van Gogh’s central unconscious fantasy is about his departed brother. By being a boisterous child, “a rough dog with wet paws,” he tried to gain his mother’s attention and affection. She acknowledged Vincent’s artistic creativity and encouraged him to further his talents.

With limited patience for Vincent’s stoic behavior, his father encouraged him to study and follow his ministry that he had proudly presented to his “First Born.” To please his father and to relieve his preoccupation with death and rebirth, he enthusiastically accepted the call to become a missionary and the role of a Christ. He had rules to follow as to study the will of another, rather than his own. He had to chose to have less than more. He had to seek always the lowest place in society and stay inferior to everyone. He had to wish and pray that the will of God be wholly fulfilled because he was able to enter the kingdom of heaven. To make his flesh obey, Vincent engaged in masochistic behavior. He practiced self-chastisement, beating himself with a whip. He served the poor, the sick and downtrodden, always abasing himself by having less than they. Feeling idle and useless in the world, he eventually suffered a spiritual crisis.

            If he wouldn’t be Vincent, for he was a replacement with no right, than he would imitate Christ and have a life which was meaningful towards a goal. A goal that he reached through preaching and then, after he failed as a preacher, through the paintings which became his sermon. He seemed to relieve his frustration and anxieties through his paintings. He painted stars and suns beyond his grasp and expressed deep feelings about human conditions. In his identification with the crucified Christ, the masochistic use of depression enabled him to accept unhappiness and death.

            “I prefer feeling my sorrow, sorrow is better than laughter,” Van Gogh wrote in Letter 82A to Theo as he became the wanderer of Christ. His restlessness and agonizing uncertainty threw him into love affairs with cousins, prostitutes and daughters of upper-class society. Fleeing pictures of those encounters were manifested in his sub consciousness and eventually, he freed it on canvas. With the death of his father in 1885, he decided to become an artist and enrolled in the Ecole des Beaux-Art. Sick again due to malnutrition, overwork and heavy smoking, his journey led him to Paris. His need to search for a father figure led him to “Pere Tangue’s” workshop. Restlessness and interpersonal relationship difficulties with his brother, Theo, led Vincent, the wanderer, to travel to the bright light of the southern region of France. Dreams to build an artistic colony which would eliminate all material need did not materialize. Vincent’s attack on Gauguin is followed by self- mutilation and hospitalization. The financial difficulties of being an emotional and monetary supplier to Vincent’s needs brought his brother and family into a crisis. After writing his last letter to his brother, Vincent goes out into a desolated cornfield and shoots himself. After Vincent’s death, his brother’s sorrow increased. He died a half year later and lies buried next to Vincent’s grave.

Van Gogh- The Depressed Individual

Vincent’s psychiatric illness was mostly known and written about during the period in Arles. To justify his emotional state, one cannot overlook the important aspects leading to his major breakdown. Since there is no medical and psychiatric history from doctors who would have been able to diagnostically classify him, various theories of schizophrenia, alcoholism, epilepsy, or major depressive illness mystify the psycho historians and lay people.

Vincent’s illness stems from an emotional imbalance, a lability and a genetic predisposition to mental illness. His illness follows the psycho-developmental process with anticipated crisis. Vincent was not psychologically strong enough to whether the “Sturm and Drang” years of a normal adolescence. Normal stressors during childhood and adolescence resulted in an unresolved separation-individuation process. Vincent’s sensitive nature could not handle losses, rejection and maturation.

In 1873, the first signs of illness were noticed during his stay in London. Fear of

separation from parents and homeland and rejection from his first love left Vincent in utter despair. The severe depression shook his emotional stability and his equilibrium and he regressed to the security of his home. Total isolation and loss of affect left him stranded from his first job.

He tried to reconstruct his life to find some type of emotional equilibrium and intellectual stability. A new form of sublimation, his religious pursuit and missionary work with the miners in the Borinage and his artistic endeavors, gave temporary psychic numbness to his mental suffering. The total break, the act of suicide, is the highlight of an arduous journey in darkness and light.

Vincent’s Psychopathology:

          DATE                                    INCIDENT                            SYMPTOM

Vincent van Gogh - The Artist

Vincent van Gogh was a complete failure in everything that seemed important to his contemporaries. He never started a family, nor earned a living, nor kept long-term friendships. His art allowed him the chance to organize his surrounding chaos and, thereby, gave him some type of equilibrium.

As with so many artists, his artistic talents were only recognized after his death. A “Genius” got discovered, and he became an “instant” hero. Van Gogh’s decision to become an artist was finalized about 1880. His drawings in the settings of the Parisian art dealers were reminiscent of historical and contemporary works. After his failure in various bourgeois professions and his rejection from his social ambitions, he seized on what he knew in theory and practice. His brother, Theo, and Uncle Mauve gave him constant support to further his talent.

Laboring peasants and miners appealed to him and he tried to transmit their mood to his own emotional feeling. Influenced by The “Golden Age” of the Dutch Baroque, Vincent ventured out to paint in oil and abstraction. He mastered the quality of tone combination and moved into the realm of conventialism. The tone and quality of color in the earlier stages became pictorial music in an age of Impressionism.

In feverish contemplation, Vincent searched to be different. He made several attempts at a mature painting but in vain. He obviously yearned for a breakthrough that would bring deliverance. His desire for artistic differentiation was not his only concern, he wanted to become famous and sell his work. Vincent experimented with the Impressionist brush strokes and the pointillist technique of stippling. He also tried out the decorative potential of Japanese prints. Artistic innovations were his motivation to become noticed; radical experiments with color and modern palette of saturated complementary colors. The southern region of France gave him the light and brilliance of outdoor painting. Broad brush strokes with impasto quality, inventive line perspectives, limited use of colors, contour style in decorative settings. His intense colors were not taken directly from nature. Brilliant yellows and deepest saturated blues were juxtaposed to one another.

It was only his painting which bound him to life - to a life of which all he asked was pictures-landscapes. They resembled him, tortured him, both trees in convulsion and landscapes, unstable, obstructed and in motion. He painted troubled skies, crossed with lightning, spinning stars, where the sun-his own reason-reeled in its battle with darkness. With vigor he captured the cataclysmic world of stormy movement seen in sloping mountains, tumultuous hills and rocks with gigantic clouds, restless branches and rapid streams, agitated trees with broken trunks, vast fields with wheat, sowers, reapers and ravens lurking into space filled his art. It was as if converging paths led nowhere, asylums gleamed in madness and raging prisoners followed their doom.

His story, wrote Wilhelm Uhde (1990), is not that of an eye, a palette, a brush, but is the tale of a lonely heart which beat within the walls of a dark prison, longing and suffering without knowing why, until one day it saw the sun, and in the sun recognized the secret of life. It flew towards it and was consumed in its rays.

Types of Depression

Van Gogh suffered from bipolar illness. This area on depression will analyze the categories of depressive illness, effects and treatments. Depressive disorders come in different forms, just as do other illness’, such as heart disease. There are several forms of depressive illness’ which vary in the number of symptoms, severity, and persistence. Depending on whether the patient is talking to a clinician, researcher, psychologist or art therapist, his or her illness may be referred to as major, clinical, melancholic, unipolar or endogenous depressions or dysthymia These differing terms can be confusing if the patient doesn’t realize that they are overlapping and not mutually exclusive. (Classnotes: Dr. Henderson).

  The DSM III -R criteria for a major depressive episode are as follows:

·        Persistent sad, anxious, or empty mood

·        Feelings of hopelessness, pessimism

·        Feelings of guilt, worthlessness, helplessness

·        Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

·        Insomnia, early-morning awakening, or oversleeping

·        Appetite and/or weight loss or overeating and weight gain.

·        Decreased energy, fatigue, being “slowed down”

·        Thoughts of death or suicide; suicide attempts Restlessness, irritability

·        Difficulty concentrating, remembering, making decisions

·        Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

  Four of these symptoms must be present nearly every day for at least two weeks in order to classify as Major depression and professional help is strongly recommended. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at “full steam” or from feeling good. Sometimes people with dysthymia also experience major depressive episodes. Dysthymics are usually morose, introverted, over conscientious, and incapable of fun (Akiska1,1983). The syndrome is approximately as prevalent as major depression and more common in women. (Weissman, Leaf, Bruce, et al., 1988).

Categories - Mood Disorders

The term clinical is a general term applied to any depression where symptoms are severe and lasting enough to require treatment. Major indicates a clinical depression that needs specific diagnostic criteria as to duration, functional impairment, and involvement of a cluster of both physiological and psychological symptoms. Melancholia is a severe form of a major depression typified by a set of physiological symptoms which respond to antidepressant medication. Unipolar means that the individual suffers from a major depression, but not from manic-depressive disorder, which is called bipolar illness. The disorder of endogenous depression (coming from within) manifests itself by a cluster of more biological symptoms, such as sleep disturbance and weight loss. Endogenous are likely to be classified as reactive depression, experiencing “precipitating” events in the three months prior to the onset of their episodes. ( Bebbington, et al., 1988).

Another type of mood disorder is bipolar disorder, formerly called manic-depressive illness and classified as the major depression as mental illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can experience any or all the symptoms of a depressive disorder.

Manic symptoms are categorized by DSMIII-R (1987) as:

• excessive “high” or euphoric feelings.

·        a sustained period of behavior that is different from usual.

·        increased energy, activity, restlessness, racing thoughts and rapid talking.

·        decreased need for sleep.

·        unrealistic beliefs in one’s abilities and powers.

·        extreme irritability and distractibility.

·        uncharacteristically poor judgment.

·        increased sexual drive.

·        abuse of drugs, particularly cocaine, alcohol, and sleeping medications.

• obnoxious, provocative, or intrusive behavior.
• denial that everything is wrong.

           Manic individuals tend to overlook the painful or harmful consequences of their behavior. They may incur horrendous debts; behave promiscuously; make poor business decisions; lose friends, family, and employment; and may even break the law and land in jail. Their impulsive and often irrational manic behaviors put them at particular risk for committing crimes (Kunjukrishnan & Bradford, 1988), having accidents, and committing suicide (Barner-Rassmussen, 1986).

Current data indicates that some bipolar patients do not progress beyond the stage of cyclothymia, i.e., short mood swings between low mood, inactivity and fatigue to high mood, high energy and overconfidence, but in a certain number of cases they will crystallize into bipolar disorder (Depue et al., 1981). Other bipolar patients experience severe depressions with mild elevations of mood and activity known as hypomania. Thus, manic episodes represent a more severe form of the malady. In extreme cases with psychotic illness, bipolar patients jump from one idea to another with no apparent connection; others experience delusions and hallucinations.

Delusions are not limited to mania. When a clinical depression becomes especially severe, delusions are not uncommon. Depressive delusions represent exaggerated feelings of helplessness, hopelessness, or guilt, such as feeling responsible for all the evil in the world.

Perry (1990) note that manic-depressive illness was identified at the turn of the century by Emil Kraeplin, an Edinburgh psychiatrist, who described several hundred cases in his care and made it clear that this was not a rare disorder. On the basis of his detailed observation, he was able to differentiate dementia praecox from manic-depressive psychosis. Since that time, the far more common among the artists than among the others. For example, the rate of alcoholism was 60% among actors and 41% among novelists, but only 3% among those in the physical sciences and 10% among military officers. In the case of manic depression, 17 % of the actors and 13% of the poets were thought to have the disorder.

Observing the striking concordance between emotional volatility and creativity, some researchers are now seeking to understand the neurobiological basis of both mental instability and creativity.

As classified in the Diagnostic and Statistical Manual of Mental Disorders in Bipolar Disease (DSM-III-R), both symptoms of depression and mania have to be present. Occasionally, a person will have a manic episode, or a series of manic episodes, with no subsequent episode of depression. They involve only one “pole”, but still classified as bipolar disorder and respond to the same medication as the classic bipolar disorder. DSM-IV will be the fourth edition and distinctly revised due to a greater degree of scientific evidence. Bipolar II Disorder, in which a person’s mood swing between intense depression and “hypomania”, a feeling of elation that is less extreme than the manic mood typical of manic-depression, is a new diagnosis and helps to prevent serious mistakes in prescribing medication. If a psychiatrist misses the fact that such a patient has mood swings, and incorrectly makes a diagnosis of ordinary depression, the treatment is likely to be with anti-depressants alone rather than with lithium added, the standard treatment for manic-depression. With bipolar patients, antidepressant alone can actually worsen the problem by “shortening the time between episodes”, says Dr. Frances, a diagnostic expert in an article by Goleman in the New York Times, April 19, 1994.

The onset of bipolar disorders will first appear in late adolescence at the average age of 20, a figure that has remained stable over the past century (Baptista, 1989). Some people have infrequent mild episodes and do not seek treatment or even recognize that they are ill. Typically, episodes of illness’ are time-limited: they come and go, last from several days to several months, and are followed by relatively normal periods of mood behavior. Without treatment, the frequency of illness, as well as the severity of symptoms, tends to increase over years.

              Bipolar disorders occur in both two sexes with equal frequency and are more prevalent among higher socioeconomic groups and does not discriminate against single or a married status. Genetic evidence shows that first degree relatives of people with bipolar mood disorder are far more likely than other people to develop this disorder. In contrast to a 0.4 to 0. 8 percent prevalence of bipolar disorder in the general population, first degree relatives of bipolar patients show a 17 percent prevalence.

           More than 75 percent of individuals with the illness of bipolar disease respond well to medical treatment and can lead productive, useful, and reasonable stable satisfying lives. Without proper medical treatment, many such persons suffer repeated periods of illness, hospitalization, and loss of productive living.

          Mood disorders are medical illness’ that produce emotional symptoms. A common-sense treatment plan involves treating the medical symptoms as well as learning how to recognize one’s own patterns of illness and developing ways of coping with them. Aside from taking the medication prescribed by the doctor, many patients and their families find help in various counseling sessions.

Treatment

Treatment is directed at lessening the duration and intensity of the episodes and preventing recurrences.

            The medication lithium carbonate was introduced for the treatment of mania and bipolar affective disorder in the early 1950’s. It has a powerful mood stabilizer effect and can be used safely. It is not a sedative or an euphoric drug, but prevents extremes of mood, either high or low. 80% of bipolar patients respond to lithium.

           Lithium’s main benefit lies in the prevention of episodes and in treating an episode after it has occurred. Manic and depressive attacks occur less frequently and are less severe when lithium is taken regularly.

           A medical evaluation including medical history, physical examination, and simple laboratory tests of blood and urine are needed. Because lithium is almost entirely eliminated from the body by the kidneys, laboratory tests of kidney function are done before starting lithium and at regular intervals thereafter. Tests of thyroid function are also advised since lithium may occasionally cause goiter (a harmless, treatable enlargement of the thyroid gland) or a mild decrease in thyroid function, hypothyroidism. A blood test of the level of thyroid hormones is usually done at regular intervals.

          Whether a person should remain on long-term therapy after an episode has ended depends on many individual factors as prior severity, duration, and pattern of recurrence of illness in the patient. If episodes are minor or widely separated, long term medication may not be necessary.

Lithium is non-sedating and side effects are rare. It is not addicting. It is safe at appropriate dosages, although when taken in excess it can produce intoxication and potentially dangerous side effects. The following early side effects are common and usually subside for several days:

·        Gastrointestinal symptoms: nausea, vomiting, diarrhea, stomach ache

·        Tremors: Fine tremor of the hands at rest

·        Thirst and frequent urination

·        Fatigue, a dazed feeling, muscle weakness

          With the exception of single large overdoses, lithium intoxication is usually of gradual onset. Loss of appetite, vomiting and diarrhea, fatigue, weakness, unsteadiness, slurred speech, muscle twitching, and severe shakiness. Although poisoning is rare with careful medical supervision, it is important to be aware of these symptoms and to recognize them. Severe intoxication or poisoning can lead to seizures, confusion, coma, and possible death. (Schvehla, 1987).

         Lithium is sometimes used together with major tranquilizers (such as Mellaril, Thorazine, Prolixin, Haldol, and Navane), or benzodiazepines-Valium-like drugs-(Klonopine and Ativan) especially in the initial phase of treatment of acute mania. These two classes of drugs have been safely used together for years in thousand of patients. Recent clinical experiences sounds a cautionary note for bipolar patients using tricyclic antidepressants or monoamine oxidase inhibitors during their depressions. For some, their use may induce hypo mania or mania, and over time the frequency of cycles may be increased. (Papolos, 1987).

        In conjunction with psychopharmacology, one should not dismiss issues of religious belief and spirituality to the care of a patient who is struggling with a psychiatric disorder such as bipolar disease. Since the genetic chromosome and personality theories are still in embryonic stages we as art therapist could enhance the ego development of a suffering patient. Dr. Harold Koplewicz, a psychiatrist working on the child and adolescent unit of Long Island Jewish Medical Center mentions about the healing effects of expressive therapies as an alternative to the traditional verbal therapy techniques. Margret Naumburg, (1973), a pioneer in art therapy stated: “As soon as original art work is encouraged, instead of dependence on models and specific techniques, the focus of a patient’s art activity is modified. He or she will begin to draw on his own inner resources and this will inevitability lead to some expression of the conflicts within the personality. Such release, drawn from both the conscious and the unconscious levels, may, in itself, have a distinctly therapeutic effect on the patient”,

( p.50).

           Art therapy builds on the pioneering work of Carl Jung, (1960). He saw value in drawings containing symbols from the unconscious that brings as in contact with our spirituality and could work as a healing agent. An individual’s spirituality usually provides a sense of meaning and purpose to life, a connection to the Transcendent (however that transcendent entity being is personally understood), and a connectedness to other sojourners who accompany one on Life’s journey.

        Although, many people use the terms “spirituality” and “religious belief’ interchangeable, and spirituality often encompasses religious belief, it can have a broader meaning. Many deeply spiritual individuals have no formal ties to organizational religion. Since bipolar disease affects not only the patient but everyone he or she is connected to, art therapy created a non threatening environment whereby one can explore the meaning of existence and suffering.

        Victor Frankl (1963) was the first psychiatrist to note the importance of spiritual health to emotional and physical well-being. Frankl’s experiences as a prisoner of war in a Nazi concentration camp exposed him to the worst in human nature, but also to the best. He was impressed that under the most bestial of conditions, some people were still able to choose how they would respond. These people would share their last piece of bread with someone who was hungry, or would comfort and console a fellow prisoner who was ill or grieving for a loved one. These people still were able to give of themselves and in some way transform the awfulness of their surroundings with love. They had qualities that Frankl identified as spiritual - the ability to find meaning and purpose, to love, and to choose how one will respond in a given situation.

These same qualities allow people diagnosed with major depression or bipolar disorder to survive the ravages of the disease. Through these spiritual qualities explored during art therapy sessions, the individual finds meaning in the chronic nature of the illness; learns to appreciate the gift of health; and finds strength to come back time and again from a pit of depression or the seductive highs of mania. We lend our ego, love, hope, and concern to the ever struggling patient. Such love frequently is the factor that empowers the patient to “hang tough” or to accept both medical and therapeutical intervention. Our own spirituality can serve as a safety rope that keeps the patient from drowning in the black waters of the depression or flying to high in the face of a manic episode.

      Does an awareness of spirituality explored during art therapy sessions discount the need for medication or psychotherapy? Absolutely not! All these sources of healing work together and enhances insight and growth on different levels. (Gilliland,1989).

Symbolism

Historians consider Van Gogh as a symbolist. Clinical art therapists study symbols as a means to gain insight into a person’s psyche. Nelson (1916) states that a symbol is a sign and differs from an antitype, which is a prefigurement of something or something or someone to come afterwards; and from an allegory, which is a figurative description. The symbol is always an object, and suggests something higher than appears to the eye.

A symbol refers to something so deep and complex that consciousness, limited as it is, cannot grasp it all at once. In this way, the symbol always carries an element of the unknown and the inexplicable, that which is not amenable to words, and which often has a numinous quality. We know the fact that symbols exist and tell the meaning behind these symbols. In the tension between knowing and not-knowing, between conscious and unconscious lies a great deal of psychic energy.

Carl Gustav Jung (1976) suggested that symbols or what he called primordial images, dominants, or archetypes have the following attributes:

I call the image primordial when it possesses an archaic character. I speak of its archaic character, when the image is in striking accord with familiar mythological motifs.

It then expresses material primarily derived from the collective unconscious, and indicates at the same time the collective rather than personal. A personal image has neither an archaic character nor a collective significance, but expresses contents of the personal unconscious and a personally conditioned conscious situation

The primordial image, elsewhere also termed archetype, is always collective,    i.e., it is at least common to entire peoples or epochs. In all probability the most  important mythological motifs are common to all times and races.

        As the principal traits of these motifs, Jung (1954) mentions “chaotic complexity and order, duality, the opposition of light and darkness, above and below, right and left, the unification of opposites in the third, the quaternary (square, cross), the rotation (circle, sphere), and, finally, centricity and radial arrangements organized, as a rule, according to a quaternary system.

        Symbols, according to Jung are “pregnant with meaning” and “image and meaning” are identical. He stresses that the symbol unlocks unconscious psychic energy and allows it to flow toward a natural level, where a transforming effect occurs. With more psychic energy available and flowing, the individual encountering a difficulty now has the possibility of pulling unconscious elements into consciousness, dealing with them, and thus transcending the problem. The problem no longer has the individual, but instead, the individual has a hold on the problem.

        How does one activate the healing power of the symbol? First of all, Tavris (1990) points out that one has to bring it into consciousness and to allow its connected energy to flow. Flow is important, for it illuminates the accuracy of what philosophers have been saying for centuries: that the way to happiness lies not in mindless hedonism but in mindful challenge, not in having unlimited opportunities but in focused possibilities, not in self-absorption but in absorption in the world, not in having it done for you but in doing it yourself. The unexamined life may not be worth living, but the unlived life is not worth examining.

Tavris (1990) suggests to examine the symbol, write about it or bring its association and amplification to consciousness are means of accomplishing it.

Ester Harding (1961) answers the question of how to activate power from the symbol to obtain healing:

It seems that for a reconciling or redemptive symbol to be fully effective four conditions must be fulfilled. First, the individual must be deeply concerned over his need; second, he must have struggled to the utmost of his ability to find a conscious way out of his dilemma; third, the symbol itself must express the life process of the unconscious, active in this particular individual; and, lastly, he must grasp the meaning of the symbol that is presented to him, not only with his mind but with his heart also, and must act upon its teaching. (p. 17)

Edith Wallace is a M.D., Ph.D. and editor of various books. Her workshop (1990) in Washington D.C. was based on the Jungian Philosophy and how the creative process works in the subconscious mind and the struggle to release creative instincts. According to her lecture, she believes that creativity is an ongoing process and we just have to allow ourselves to free the mind and let the creative flow occur. With the help of her own paintings she demonstrated how the unconscious works and its ability to free the path of obstacles during the creative activity. She emphasized the Jungian principle that man does not strive for wholeness, he or she is born with it. What we have to do through our life is to develop this inherent wholeness to the greatest degree possible.

Wallace believes in the Jungian Archetypes as a content of the collective unconscious which is universal. They must be advantageous to the individual and to the race, otherwise they would not become part of man’s inherent nature. She stressed that creative people need to have a periodic withdrawal from the world in order to recover one’s balance. Many times she stepped down in the abyss, the dark unknown that frightens everyone. Wallace’s paintings reveal the darkness of her spirit but a glimpse of light was not far away. She believes on choices, going toward the light or regress back to those muddy, dark stairs leading to the abyss.

Tension, conflict, stress, and strain are all feelings that arise from imbalances in the psyche. Creative processes allow a flow of insight towards conflicting ideas and balance will occur. Regression was beneficial to her. Wallace took it as an opportunity for renewal.

            Dr. Wallace stresses that most of the creative people are the introverted intuitive type personalities. An intuitive introverted person is often regarded as an enigma by his friends and as a misunderstood genius by him or herself. Most of the time, they lose touch with reality and therefore unable to communicate effectively to others. Their art work is the link to the outside world.

Freud’s theory (1913) is based of layers of unconsciousness. The deepest and most inaccessible is the unconscious and the most accessible but not in awareness is the preconscious mind. What we are aware of is our consciousness. The most primitive or forbidden impulse is the id. The id needs to be constantly satisfied and if not, emerges in disguised forms. Only when disguised, are the able to pass the “censor”. Repressed wishes and impulses manifest themselves in psychological symptoms. According to Freud, the creative person experiences a need to represent his conflict or his ungratified wishes by artwork.

Art is a facilitator to release those hidden wishes in a cathartic and communicative sense. In a manner analogous to dream work, art work utilizes primary process mechanism to distort and disguise visual motor percepts. The formulation of a primary-process class is often an unconscious mechanism. With the help of the secondary process, an external representation of the percepts is expressed in visual forms.

Sublimation is based on a Freudian psychoanalytical theory. It embraces a multitude of mechanism. The include displacement, symbolization, neutralization and drive energy, identification and integration. Sublimation is a powerful defense mechanism, highly sophisticated and usually postpones instinctual gratification and channels of the drive energy. It requires ego strength and intelligence and involves the primary and secondary thinking process.

          Faced with anxiety and fear, our ego mobilizes many defenses as denial, projection, reaction-formation and sublimation. The expressive art is a story of transformation. It stimulates sublimation and the conscious, preconscious and unconscious processes.

MacGregor (1992) pointed out that Freud and Jung recognized the existence of a “phylogenetic heritage.” “Fixed dream symbols” are common to all mankind and coexist with the more common private symbols in the individual unconscious. Vacharro (1973) feels that Freud posits that all weapons and tools are used as symbols for the male organ; e.g., plough share, hammer, gun, revolver, dagger, sword, etc. Many landscapes, especially those containing bridges or wooded mountains are described as genitals. Castration may be presented by baldness, haircutting, loss of teeth and beheading. As a defense against castration one may see multiple forms of the penis (e.g., several guns) or an animal (e.g., lizard) whose tail, if pulled off, is regenerated by new growth. Also, symbols used in mythology and folklore may be used in symbol formation; the fish or snail substitutes for siblings or little children or pregnancy (unwanted sibling). Hollow objects (chest, boxes, containers, etc.) are used to symbolize female genitalia. Genitals are often represented by other parts of the body; the male by the hand or the foot; the female genital orifice by the mouth, the ear, or even the eye. Human secretion often are used interchangeable; mucus, tears, urine, semen. Motor activities (running, flying, falling, movement of vehicles, etc.) represent sexual impressions. In childhood, such actual movement is associated with the real experience of genital stimulation. Water is female; coming out of the water may represent parturition; jumping into the water may represent a wish to return to maternal comfort. Arnheim (1966) concludes:

Freud’s conception of symbols, derives, of course, from his interpretation of dreams. Carl Gustav Jung and other writers, such as Erich Fromm, have opposed his view and pointed out that symbols serve to reveal rather than to hide their referents.

We are beginning to understand that during sleep man reenters into fuller possession of a basic and most valuable capacity of human mind, which consists in representing abstract states of affairs by striking images. It is this capacity, badly impaired during our waking hours by Western culture, on which the artist also relies. Far from hiding their referent, artistic symbols give tangible appearance to ideas they represent. They revive and clarify the issues of human existence. (p. 219-220)