Fig. 16.1
Author: Maurits Cornelis Escher
The pretense of depriving psychopathology of its contextual dimension means renouncing the reality that is the person. The body of psychopathology cannot be an ordered ensemble of neurons, hormones, structures, and substances. No such body exists if a physical, relational, social, and theoretical context to refer it to does not exist. The body is also a representation, a formula based on language. It is also an experiential ensemble, or ideological concept.
Merleau Ponty wrote: “Corporal space can be distinguished from exterior space and envelop its parts instead of unfolding them, because this space is the darkness in the room necessary for clarity of the spectacle, the depths of somnolence or the reserve of vague potency over which the gesture and its objective stand out, the non-being zone before which precise beings, figures and points may appear” [2].
We must be capable of paying attention to the body, not as a surface to be demarcated, but rather a place that is theoretical, political, affective, aesthetic, sensory, relational, etc., and also takes into account that, in this sense, the limitations imposed on thought by logical discourse are not dismissible.
16.3 Experience and Language
In addressing mental illness with psychotherapy, “words” and logical thought have taken precedence as preferred methods. This implies that a person is capable of using them. In other words, that the person is disposed to construct and be constructed based on logical thought, and equipped with language that allows them “to tell and be told based on words.”
However, with some pathologies or with determined aspects related to them, experiences take place that are far from capable of being constructed as structured thoughts and they cannot be approached with verbal language. On occasions, these experiences are disassociated from cognition and affect, and remain in psychic space as flashbacks that are only accessible on a sensory level.
Within this context, we ask ourselves about the viability of a expressive–communicational process that is not ruled by cognition, implying what some authors refer to as bottom-to-top processing [3], allowing access to “important regulating, sensorial-motor, holistic, autobiographic, stress-reducing functions, based on images inherent to non-verbal processing modalities” (Siegel in the prologue to Ogden) [3]. This is a process that implies cognitive and affective levels, but also physiological, sensorial, motor, social, and cultural levels.
Human beings, just like the other living beings, possess memory linked to the species and another memory related to their own existence as individuals. Both of them are essential for their biological survival, but for psychological survival, they need another memory, interlinked with their relational, cultural, and transcendent dimension. Thanks to the latter, it is possible for them to make experience something lived, to transpose affect, knowledge, discourses, and the unconscious within that which is sensory, generating spaces and relationships that give meaning to their everyday life. In essence, the work of an artist consists of transforming feelings into something visible, making an ensemble of inscriptions on the outside: strokes, movements, volumes, etc., that allow them to link their memory to the memory of the world in an explicit and long-lasting fashion.
One might say that all artistic products imply symbolization, but also implicated therein is movement, the footprint of that movement, the memory over which it passes and the memory proposed within as a new representational configuration. This movement, understood as an exteriorization process, thanks to which that which is sensitive being spatially and temporally dimensioned, transforms the thought that it represents, thereby affecting perception in and of itself. As such, all artistic production alludes to subjective production interdependent on the context and the subject carrying it out, configuring it as an artistic object. In this sense, it includes at least a social–political (inter-subjective) dimension, another cognitive–affective (intra-subjective) dimension, and a poetic–transcendental (artistic) dimension.
16.4 Gender, Art, and Health
As far as the gender perspective is concerned, we could ask ourselves if it is possible to speak of a differential artistic production in relation to gender, or if a correlational component derived from the different subjective meanings of the artistic experience in relation to this variable exist. One might also consider (mental) health in relation to art and gender, as both things are social constructions modulating the perception–interpretation–representation continuum and operate thereupon qualitatively, according to whether one is man or woman, artist or not. Last, one might argue as to a therapeutic method that works based on the interaction between different mental positions, the models and ideals socially maintained and constructed regarding femininity and masculinity, and the artistic products and processes that are produced according to them.
The construction of what we call identity includes an identification process in which, at minimum, biological, cultural and biographical elements, and the social structure are involved. For healthy development, the baby must be within a setting they can handle, and to this end, it needs someone else capable of sustaining, protecting, providing, and feeding their experience. This mediating function must exist, beyond whoever holds it, so that they, in turn, may develop it.
When gender roles (masculine/feminine) are articulated around rigid social models that counter masculine omnipotence with feminine abnegation, parental figures assume differentiated forms that are expressed through relations and attitudes such as power/submission, activity/passivity, strength/suffering, and control/guilt. As a consequence, the caretaking functions are divided, and they become vertebrae in the masculine–defense–strength–external/feminine–sustain–sensitivity–internal duo.
The internalization of a complete caretaker figure is mandatory for a subject’s development, regardless of whether they are biologically a man or woman. When this figure breaks or proves to be insufficient, it promotes a gender construction based solely on the biological factor, constituted as a stereotype, leading to over-identification/rejection of social bonds. However, and additionally, it becomes a vulnerability factor that may be at the base (at the origin) of, or modulate, different psychopathological alterations that are either conflictive or structurally deficient in nature.
On occasion, the intolerable nature of a thought, affection or sensation is not considered in relation to another one that is better or more credible; rather, it is the fact in and of itself of being unable to self-sustain when faced with it that is intolerable. When this sufficiently good maternal function fails, as Winnicott so magisterially presents, it may be that it is impossible for an individual to be in the world without warning themselves, no longer of a lack, but as a result of an empty space.
“Spaces cannot be reduced to the concepts of I-think as conscience, the instruments with which nature draws on the landscape of subjectivity. As such, they must be experienced outside of time, outside of history, because they are outside of the interior of conscience.” [4]
16.5 Clinical Examples
16.5.1 Lola
Reality may be taken as a maze of relations (as well as an ensemble of correspondences) in which the body and language form part of the same system that gives the subject meaning, as they are called upon to be activated in each new situation in which the subject finds themselves. Both body and language share something we might call an updating vector that operates in two senses: in conservation and in transformation. There is something in the corporal element that remains and something that is moved by experience and transformed by it, and the same thing occurs with language (especially nonverbal). In this fashion, every experience is engraved in a subject’s mental framework, mobilizing their structure, ascribing it to the body and language in order to bequeath it with subjectivity.
Language and body embrace the experience of living and give it meaning. Habit is the base upon which different experiences are outlined, the condition for the development of new experiences, which puts the instant when it becomes real into play, and in which it is possible to play or create, to imagine something different, and to prepare for change. “One must be capable of imagining something different than what there is in order to be capable of wanting; and one must want something different than what there is in order to be capable of imagining” [5]. In this sense, art facilitates a certain “resonance” between the body and language, thanks to which the capacity for self-regulation is increased, and the capacity to create changes along with it.
The factual condition of artistic products induces one to collate, evaluate, realize, detect problems, try solutions, make adjustments, etc. Experiencing an achievement, even when not absolute, provided by artistic work hearkens to the very capacity to modulate, facing every situation from the emotion, sensation, and thought it produces.
“In poiesis, everything is radically different. The nature of what could be is attributed to that which is presented in the creation or production. It is always the result of doing, of facere (fictio). More than resembling existence, it is a revelation of its conditions of possibility.” [6]
Lola is a 63-year-old woman who has suffered a brain stroke affecting the left side of her body. Her motor capacity appears to have recuperated, but she says she has lost her freedom. Her husband, recently retired, has taken charge of the situation and controls all of her movements, preventing her from doing anything that would imply decision-making or change.
At the beginning of the session, she appears uneasy, constantly looking every which way, and when she is asked to close her eyes to remember, for example, a landscape, she is incapable of doing so. She sits on the edge of the chair, which is too high for her, because she says she needs to have her feet on the floor, and she keeps her arms on the armrests. Her body language is ambiguous; she appears to be anchored to the chair and about to take off running all at once.
She has always lived under a man’s protection; first her father, and then her husband. She has never needed anything that had to do with taking care of herself. Since she married, she has dedicated her life to her family. Her day-to-day always consisted of the house and children: she got up, prepared breakfasts, took care of her family, and once they had all left, she got ready and went to the market. There, she met up with other women with whom she chatted and drank coffee. Then she went home and took care of domestic tasks, meals, and once again, taking care of her children and husband.
Now her husband does the grocery shopping for her. He says that she cannot take care of everything and that it is better for her to rest. Lola does not understand what is happening; she feels guilty and ungrateful for his care, and explains a feeling of intense sadness and malaise that she feels as an after effect of the stroke.
After considering different materials, we worked with play dough, which interested her because she said it allows her to exercise her hands, especially the left one. From this point, we focused especially on the connection between the imagination and the manual realization of what was imagined, proposing experiences to her that allow her to effortlessly experience this connection. We worked with very basic shapes: a ball (that she called a bouncy ball), a ball with a hole (a washing-up bowl), and a solid cylinder (worm).
It is easy to observe her great difficulty in imagining, and especially in separating herself from the literality where she finds herself, and in thinking of some change; with each new suggestion, her breathing becomes ragged and she begins looking at her fingers with greater unease (perhaps anxiety), so we suggest that she tells us something that she likes. After a moment of uncertainty, she tells us that she likes flowers. When we show our curiosity regarding which ones, she appears indecisive, and finally says, “roses.” We ask her to think about a rose, and then go one step further. “Once you have the image in your head, don’t you think you could make a rose out of play dough?” we affirm. Her response is immediate and unequivocal; both her words and her body say no, she cannot, that is impossible.
Then we ask her if she can make a stem. She looks at us, surprised, and affirms, “Yes, of course!” and makes a thin cylinder from green play dough. Then we ask her what the rose is like, what it is made of. She says it has petals, and we ask her if she can make one. She is still surprised, and makes one. We ask her how many it has, and she says she doesn’t know. We ask her if it has two, and she says no, there are more, so she continues making them. When she has several, she makes something that she says is the centre of the flower. Then we suggest that she make the flower. She places the petals around the center, and from there, she adjusts sizes, the number, and position. Then she sticks the flower on the stem and adds leaves.
Her face has totally changed, and she looks at the flower she has made, half-surprised and half in admiration. We comment that it is perhaps not exactly as she had imagined, and we ask her what she thinks of it. She says that she likes it, and then adds that life is that way: sometimes, one thinks about how things will be, and then they don’t turn out that way, but, oh well.
Working with art allows one to bring what they are feeling to the body, and then manage it through materials. Finishing implies a “retreat,” but it is also conserving that which has been achieved. It is difficult for Lola to spurn her flower, but more than anything, she will not allow it to be spurned by others; she will protect it from critical voices that undervalue it or try to invalidate it. It is also a way for one to become aware of responsibility with regard to oneself and one’s life, making it possible to receive and welcome what arises from it.
In this fashion, a receptive, and not reactive, position is facilitated; it allows one to work with processes and not with results, with personal rhythms, considering subjectivity as a founding element in creative value.
16.5.2 Julia
“… being or feeling like a man, woman, or however one wishes to live gender, is a substantially corporal experience, a lived experience made real, situated in determined historical, social and changing coordinates. In other words, a process produced through basically corporal actions: ways of feeling, walking, talking, moving, dressing, adorning, touching, feeling emotion…in continuous interaction with others, actions that are modified in time and in space.” [7]
Related posts:
Gender and Corporality, Corporeality, and Body Image
Improving Our Science in Psychosis Research with a Sex- and Gender-Based Analysis
Dysmorphophobia: From Neuroticism to Psychoticism
Psychosis and Gender: Everything You Always Wanted to Know About Sex (and Gender) in Psychosis but Were Afraid to Ask
Somatoform and Factitious Disorders
Psychosexual Development and Sexual Dysfunctions
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