Creativity Belongs to the Person, Not to Disease

Juan J. Lpez-Ibor, Jr. and Mara-Ins Lpez-Ibor

Keywords: creativity, patho-biography, Saint Teresa, visions

n the paper, From the Visions of Saint Teresa of Jesus to the Voices of Schizophrenia, Cangas, Sass, and Prez-lvarez (2008) take an original approach to patho-biography that is very welcome. The temptation to designate historical individuals or characters of fiction as suffering from mental disease has always produced disagreeable feelings in me. This sort of abuse of psychiatry and of the people in question is parallel to the abuse by the media or lay citizens when they describe, say, an especially violent murderer as a schizophrenicforgetting that the vast majority of people with schizophrenia are not in the least violent. Having read Santa Teresas writings during my adolescence, well before I even considered entering medicine, I reacted to comments about her alleged psychiatric illnesses with uneasiness, to put it mildly. The Santa Teresa of La Vida de la Santa Madre Teresa de Jess (her autobiography), of the Camino de Perfeccin, and of the El Castillo Interior was surely not a mental patient, it seemed to me. The same would apply to San Juan de La Cruz, Jean DArc, Don Quijote, Sancho Panza, Edipus, and Clitemnestra, to mention a few. Even van Goghs paintings did not seem to me the produc-

tions of a patient with schizophrenia or epilepsy. Of course all of them may have suffered, at certain periods of life, symptoms attributable to a mental disorder, but their creativity rested elsewhere, and was often manifest during healthy periods of their lives. After years spent fighting the stigma of mental diseases, and after organizing several exhibitions of works of art of people with mental diseases, we came to the conclusion that creativity and singularity belong to the person, not to the illness. Some of the diseases of these individuals may have being accidents (van Goghs hallucinations and psychotic symptoms, for example, were most probably due to intoxications with absinthe, then rich in hallucinogenic alkaloids such as tujone), or, together with other life circumstances, may have had unspecific influences on the persons condition. In contrast with many other psychiatric disorders that are represented in ancient Greek and Roman literature, there are no descriptions of individuals with schizophrenia in the Greek and Roman literature dating from the fifth century bc to the beginning of the second century Ad (Evans et al. 2003), and several authors have speculated that schizophrenia did not exist before the eighteenth century (Ellard 1987). Caution is important when dealing with mental health and religious issues in contrast with creativity. The creativity of people suffering from bipolar disorders is well recognized (Jamison 1993) and

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the same applies to alcohol and drug intoxication. Tellenbach (1986) has also written on the creativity of depressed persons, although he refers more to the disposition of mood (Schwermut) than to clinical depression as such. The link between melancholia and genius put forward by Aristotle has often been misinterpreted. The philosopher was considering the melancholic temperament and not the melancholic illness as we would understand it today. Of the four temperaments, it is in his view only the melancholic that is gifted with creativity. The sanguine person seeks the immediate pleasures of life, the choleric one considers himself powerful and dedicates himself to manifesting this power, and the phlegmatic individual is disconnected from life and seeks to live without effort or pleasure. The melancholic temperament leads to creativity because of the predominance of doubt, reflection, and dissatisfaction with the miseries of life. Freuds notion of religiosity as a collective obsessive neurosis is totally mistaken, in my view. The three main themes of obsessions are cleanliness, order, and guilt. In none of these cases is the theme the goal of the action; rather, it is a strategy to contain anxiety. As a consequence, patients with obsessions and compulsions about dirt and cleanliness tend to be dirty themselves, because the real purpose of their compulsions is not in fact to be clean but rather to satisfy a ritual. When order becomes the ultimate goal, it no longer contributes to efficient performance or aesthetic significance. In the same way, a religious practice guided by a rigid individual conscience is the opposite of a religiosity based on faith, hope, charity, and integration into a community of the faithful. There are several patho-biographies of Saint Teresa of Jesus. The two that seem to me most interesting are those by the internist Nvoa Santos (1932) and by the psychiatrist Poveda (1984). Both deal with tangible symptoms that could eventually support a clinical diagnosis, and not only with religious phenomena or experiences. This is the case with the mark in the Saints heart that is kept at the monastery of Alba de Tormes, and which is said to have resulted from a traspasamiento (piercing through) or transverberacin (transverberation, a neologism), that is, the penetration of the chest of the flaming arrow by an angel. The mark has been

identified either with the sulcus atrio-ventricularis or with the scar of a myocardial infarct. In this way, conversion, dissociative, anxiety, depressive, and somatization symptoms are considered and evaluated. Nevertheless, it is highly problematic to attempt to build a clinical diagnosis on them. Although it is quite probable that Saint Teresa experienced anxiety and depressive feelings, these are not, per se, exclusive manifestations of anxiety and depressive disorders. Max Schelers (1923) writings on feelings are essential for understanding the amazing richness and intensity of the experiences Saint Teresa described. Two aspects are important. First, there is an essential purpose in emotional life. Just as knowledge (cognition) allows access to the world of essences, emotional feelings allow an immediate access to the world of values, according to Scheler. A second point to note is that diverse feelings can be simultaneously present in the same person, meaning that there is a stratification of the emotional life. According to Scheler, four layers of feelings exist: (1) Sensory feelings (Sinnliche Gefhle), also called sensationsfeelings (Empfindungsgefhle); (2) vital feelings (Lebensgefhle), also called body feelings (Leibgefhle); (3) pure feelings of the ego (reine Ichgefhle), also called feelings of the soul (seelische Gefhle); and (4) spiritual feelings (geistige Gefhle), also called personality feelings (Personlichkeitgefhle). Sensory feelings concern parts of the body; vital (body) feelings, the body experience as a whole; pure feelings of the ego (animic), the environment; and spiritual feelings, the world of meanings. Schelers contributions had an immediate application to psychology and psychiatry through Kurt Schneiders (1921) distinction between nonreactive (endogenous) depression as opposed to purely reactive depression. The first is characterized by the presence of nonmotivated vital feeling (vital sadness), and the second by another kind of feeling, this time animic, which is reactive to world experiences (psychic sadness, the sadness for ordinary life experiences). Lpez-Ibor, Sr. (1950, 1966) applied the same distinction to anxiety. He describes a vital type of feelingnon-reactive, endogenous, and somatichat tends to be present in neurotic disorders, and also what he calls an animic feeling that belongs to healthy life experiences.

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What are the feelings described by Saint Teresa? What she writes is quite different from what we typically hear from our patients. At certain moments, Teresa does allude to sensations and bodily experiences, but these references occur en passant and the experiences seem to be enfolded in feelings of another nature. That is, they are not the consequences of everyday experiences, but seem to belong to a realm of spiritual feelings, which in a sense transcend any concrete experience of the body or world. Koestler (1954) in the same sense wrote about what he called oceanic feelings. Koestler introduced this term in his Invisible Writings, when he narrates his decision to burn his bridges and jump off the track after a late-night discussion on determinism with the Russian student Orochov. Koestler was referring to the fact that his decision was not the consequence of a rational process, but of something deeper. The arrobamiento (becoming entranced) of Saint Teresa is an oceanic (Koestler) or spiritual (Scheler) feeling. Nvoa Santos underlines an important aspect, namely the fact that such feelings are impossible to describe in words. They are ineffable, more ineffable than other feelings because they entail a deep, unique, and personal experience that can only be described in metaphorical terms. In their paper, Cangas, Sass, and Prez-lvarez take a totally different approach. To understand unusual forms of experience and behavior, they do not consider Teresas personal crises as manifestations of a mental disorder but, rather, examine the social components of these crises in the context of her historical circumstances. They identify two factors: increasing individualism and reflexivity, which are the precursors of the Zeitgeist of modernity. In this context, Saint Teresa belongs to the group of women who have not been at ease with their feminine role in a society where gender parity and individualism were strongly confronted. Many such women joined a religious order where, strangely enough, they felt protected. The biography that the poet Octavio Paz (1982) wrote about the famous poet Sor Juana Ins de la Cruz, who lived in Mexico, is a beautiful example of this. The paper From the Visions of Saint Teresa of Jesus to the Voices of Schizophrenia has fur-

ther importance. The authors way of analyzing Saint Teresas experiences without the corset of a psychopathological prism offers a lesson for clinicians practicing in mental health; it shows the importance of going beyond current classification approaches to reach the person who is ill. The issue is not only to discover the illness in the person but also the person in the illness, as the humanistic Spanish physician Maran recommended. Furthermore, by showing that extraordinary experiences also belong to the array of (normal) human experiences, mental illnesses and those who suffer from them will be less stigmatized.

References
Cangas, A. J., L. A. Sass and M. Prez-lvarez. 2008. From the visions of Saint Teresa of Jesus to voices of schizophrenia. Philosophy, Psychiatry, & Psychology 15, no. 3:239250. Ellard, J. 1987. Did schizophrenia exist before the eighteenth century? Australia and New Zealand Journal of Psychiatry 21:30618. Evans, K., J. McGrath, and R. Milns. 2003. Searching for schizophrenia in ancient Greek and Roman literature: A systematic review. Acta Psychiatrica Scandinavica 107:32330. Jamison, K. R. 1993. Touched with fire: Manic-depressive illness and the artistic temperament. New York: Free Press. Koestler, A. 1954. Invisible writing. The second volume of an autobiography, 193240. New York: Collins & Hamilton. Lpez Ibor, J. J., Sr. 1950. La angustia vital. Madrid: Paz Montalvo. . 1966. Las neurosis como enfermedades del nimo. Madrid: Gredos. Nvoa Santos, R. 1932. Patografa de Santa Teresa de Jess. Madrid: Morata. Paz, O. 1982. Sor Juana Ins de la Cruz, o las trampas de la fe. Mxico: Fondo de Cultura Econmica. Poveda, J. M. 1984. La psicologa de Santa Teresa de Jess. Madrid: Rialp. Scheler, M. 1923. Wesen und Formen der Sympathie, 5th ed. Gesammelte Werke, 7, Francke, BernMnchen, 1973. Schneider, K. 1921. Die Sichtung des emotionalen Lebens und der Aufbau der Depressionzustnde. Zeitschrift fr die gesamte Neurologie und Psychiatrie LIX:2816. Tellenbach, H. 1986. Depresin (Schwermut) en los genios. Anales de la Real Academia Nacional de Medicina (Madrid) 103:36981.

About the Authors

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About the Authors

Adolfo J. Cangas is a Senior Lecturer in Psychopathology and Intervention and Treatment Techniques at the University of Almera (Spain), and runs the Masters program in the Treatment of Severe Mental Disorders. He leads a research group on psychoses and has published several articles in the specific field of hallucinations. He can be contacted via e-mail at: ajcangas@ual.es Lindsay B. Fletcher is a doctoral student in clinical psychology at the University of Nevada. She can be contacted via e-mail at: lindsaybfletcher@ gmail.com Jos M. Garca-Montes, clinical psychologist, is assistant professor at the University of Almera, where he teaches Theories of Personality and is involved in clinical doctoral training programs. His research has focused on etiological factors and psychological treatments of psychotic symptoms. He is now developing a new line of research concerning the relevance of cultural, historical, and social factors in understanding drug consumption and addiction. He can be contacted via e-mail at: jgmontes@ual.es Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada. An author of 32 books and over 400 scientific articles, his career has focused on an analysis of the nature of human language and cognition and the application of this to the understanding and alleviation of human suffering. He can be contacted via e-mail at: hayes@unr.edu

Elena Ibez-Guerra is Professor of the Psychology of Personality at the University of Valencia. She is a Doctor in Medicine and a specialist in psychiatry. She is the author of several books, notably Personalidad (Personality), co-edited with Prof. Pelechano, and Psicologa de la Salud y Estilos de Vida (Psychology of Health and Lifestyles). She is founder and first President of the Spanish Society of Oncological Psychology, an area in which she has published numerous articles in national and international journals. She serves on the editorial board of several journals, including Boletn de Psicologa, Psicologa Poltica and Psicothema. She can be contacted via e-mail at: ibanyez@uv.es Juan J. Lpez-Ibor, Jr. is Chairman and Director, Institute of Psychiatry and Mental Health, San Carlos Hospital, Complutense University, Madrid (Spain); Director, WHO Collaborating Centre for research and training in Mental Health (Madrid, Spain); and the author or co-author of 53 books, 219 chapters, 331 research papers. He is Past President of the World psychiatric Association, the International College of Psychosomatic Medicine, Spanish Society of Psychiatry, Spanish Society of Biological Psychiatry; Fellow or Honorary Fellow of the Real Academia Nacional de Medicina (Spain), the World Psychiatric Association, the Royal College of Psychiatrists, and the Association of European Psychiatrists. He is also a member of CIBERSAM (Spanish Research Network on Mental Health). His research interests include psychopharmacology, neuroimaging, psychoneuroendocrinology, and phenomenology

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in psychiatry. He can be contacted via e-mail at: jli@lopez-ibor.com Mara-Ins Lpez-Ibor is Professor of Psychiatry, Department of Psychiatry and Medical Psychology, Complutense University, Madrid (Spain). She can be contacted via e-mail at: mlopezibor@ med.ucm.es Rogelio Luque is Senior Lecturer in the Department of Psychiatry, University of Crdoba, Spain and Consultant Psychiatrist in the Psychiatric Hospitalization Unit, Hospital Reina Sofia. He has a long-standing interest in psychopathology of psychosis and philosophical and historical aspects of psychiatry. He has published widely on these topics. He can be contacted via e-mail at: rluque@ telefonica.net Marino Prez-lvarez, clinical psychologist, is Professor of Psychopathology and Intervention and Treatment Techniques at the Psychology Department of the University of Oviedo (Spain). He participates in several doctoral programs at different Spanish universities. He is co-editor of the Gua de tratamientos psicolgicos eficaces (Guide to effective psychological treatments), in 3 volumes, and co-author of La invencin de los trastornos mentales Escuchando al frmaco o al paciente? (The invention of mental disorders:

Listening to the drug or to the patient?). He is Associate Editor of the Spanish journal Psicothema. His principal line of research at present focuses on the development of a person-based contextual therapy for psychoses. He can be contacted via e-mail at: marino@uniovi.es Louis A. Sass is Professor of Clinical Psychology at Rutgersthe State University of New Jersey. He is the author of Madness and Modernism and The Paradoxes of Delusion, and of numerous articles on schizophrenia, modernism/postmodernism, phenomenology, and hermeneutics. He can be contacted via e-mail at: lsass@rci.rutgers.edu Roger Vilardaga is a doctoral student in clinical psychology at the University of Nevada. He can be contacted via e-mail at: roger.vilardaga@ gmail.com Jos M. Villagrn is consultant psychiatrist, Head of the Psychiatric Hospitalization Unit, Hospital of Jerez, Cdiz, Spain. His research interests include psychopathology, recovery from psychosis and philosophy of psychiatry. He has published widely on these topics and co-edited with Rogelio Luque the book Psicopatologa descriptiva: nuevas tendencias (Madrid: Trotta; 2000). He can be contacted via e-mail at: jmaria.villagran.sspa@ juntadeandalucia.es

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