Medfed book

SCHIZOPHRENIA & ART Two essays by Erica Crompton, a patient diagnosed with paranoid schizophrenia

INDEX Essay one ‘A look at schizophrenia & art ’

Page 3

Essay two ‘Are all arti sts ‘mad’?’

Page 22

A LOOK AT SCHIZOPHRENIA & ART INTRODUCTION This paper examines the relationship between art and schizophrenia, and artist and patient; and poses the question as to whether art can change our stereotypical views on schizophrenia – specifically, what schizophrenia is and what people believe about those who suffer from it.

Current research informs us that schizophrenia is still stereotyped (Rethink Mental Illness, 2017). A recent survey of 1,500 people by the charity suggested schizophrenia is still widely misunderstood. Fifty per-cent of the people who took part in the survey mistakenly thought the illness was defined by a split personality and a 25 per cent believed it definitely led to violent behaviour (Rethink Mental Illness, 2017). Figures mirrored that schizophrenia is still largely misunderstood, especially in terms of employment. For example many people with schizophrenia want to work (Secker et al, 2001), but their employment rates are estimated at eight to 35 per cent (Gaite et al, 2002).

Art and acute mental distress, together, can be traced back Centuries. As far back at the 17th Century, the publication of Don Quixote (De Cervantes, 1602) tells of one man’s loss of touch with reality that would be recognised as ‘disorderly’ by psychiatrists today (Pinto, 2007). In art of a more visual style, The Bethlem Museum of the Mind (2014) holds photographs of mental patients dating to the 1850s. However, ‘schizophrenia’ was only classified as a distinct mental disorder in 1908, by the Swiss psychiatrist, Eugen Bleuler (Ashok et al, 2012).

This paper will examine art and artists working on the theme of schizophrenia and examine whether their work has an impact on the existing stigmatisation of the illness. From Medieval paintings by Italian masters, to the more modern ‘Outsider art’ of Victorian times and beyond, right through to fine art

by those with the condition. In addition to historical and contemporary examples of schizophrenia portrayed in art, this paper will also look at the influence of art in today’s society and conduct interviews with the public and experts about their relationships and thoughts on art, and on the relationship of art with schizophrenia and acute mental distress. This will establish the potential of how far artistic impressions of schizophrenia can go towards challenging stigma to schizophrenia.

METHODOLOGY ‘ The method in the madness’

Secondary resources – books, journals and newspaper articles Firstly, to set the scene and examine this history of mental distress portrayed in art the author uses secondary resources of contemporary articles and papers in scientific journals and newspaper articles such as The Guardian and The New York Times as well as books on Art Brut, The Prinzhorn Collection and how to read Outsider art.

Interviews Through exclusive interviews with professors of psychology to established artists living with schizophrenia, through to surveying a population novice to schizophrenia – the people whose minds we seek to change. This is an ambitious look at how we can make a difference to the lives of people with schizophrenia using art as the vehicle du jour. Whether that’s through people with schizophrenia, using art to express how they feel and think, for example Alice Evans or George J Harding, who according to his website (Harding 2014), his paintings explore the extent and limits of his own inner worlds of his own schizophrenia. To established modern artists such as Max Ernst introducing Brut Art (that is art by people with schizophrenia among others) to The Surrealists for inspiration (Beveridge, 2001).

Next, resources and data have been secured using exclusive interviews with experts and service user experts talking about art past and present. Professor of Psychology Craig Jackson talks about Goya and his depictions of mental distress, specifically psychosis, and the problems of ‘service user art’.

Photographer, PhD student and service user Alice Evans then goes on to talk about how art has helped her. Both interviews follow an ethical form procedure through Staffordshire University and both speakers have been offered anonymity. However, both Evans and Jackson are already working openly for a greater mental health awareness and are therefore, Evans is open as ‘schizo-affective’ within the public domain.

Primary resources To examine what extent art has an impact today, in the digital age, on shaping the thoughts and opinions of the general public, the author used the primary resource of data collection from Survey Monkey, a cloud-based software company providing free, easy access surveys for researchers and businesses.

The sample size used for the survey was 640 people from across the globe on the author’s LinkedIn account spanning all industries but with a focus on mental health and media fields. A total of 93 responses were received. There has been a slight bias to digitally-literate people which could exclude the population of homeless people for which schizophrenia, in particular psychotic illnesses and personality disorders, are a common complaint (Fazel, 2008).

The survey was also placed in open forums such as twitter and Facebook to gain further insight from a more regional audience (regional being the West Midlands, UK). As such, study participants were recruited from far and wide on the premise that art, and depictions of schizophrenia in art should be accessible to all. Following completion of the questions, the data was analysed by Survey Monkey and outlined in the appendix.

The following methods, it is hoped, should give a broad overview of the question and themes the essay addresses, and a 360 degree perspective on depictions of acute mental distress in the art forms.

CHAPTER ONE HISTORICAL STIGMAS ATTACHED TO SCHIZOPHRENIA IN ART ‘Psychos & psychoses’

‘Mad-art’ – or art by people with schizophrenia for the purposes of this essay – sits within the art world as ‘Outsider art’ or ‘Brut art’ standing for all that is raw and untrained and socially excluded (Fol, 2015). However, depictions of madness can be traced back as far as medieval times. For example, Vittore Carpaccio’s 1496 painting ‘The Healing of the Possessed Man at the Rialto’ (see Figure 1). Set in the streets of Venice, this painting shows us how mental illness was understood and treated in the middle ages – as people demonically ‘possessed’. Carpaccio’s painting tells of a man being miraculously healed by a priest amidst the human drama of the Rialto Bridge, painted in the style of Vivarini and the Bellini. In medieval times, mental illness was seen as a religious rather than social or medical problem. (Jones, 2015).

Today, the relationship between religion and schizophrenia is still blurred (Crompton, 2017) and in many third world countries religion is still viewed as demonic possession. But the blurring boundaries doesn’t end there as people with schizophrenia tend to be very religious themselves. In a Swiss study of 108 people with schizophrenia, fifty-eight percent of patients identified as Christian, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various

minority or syncretic religious movements, and only 19% had no religious affiliation. (Borras, 2007).

The misunderstanding of schizophrenia in art continued into the C18th.

William Hogarth’s ‘The Rake in Bedlam’ is perhaps the most well-known for this (Jones, 2015). Set in London’s Bethlem Hospital (also commonly referred to as ‘Bedlam’) this image portrays a young man whose career of gambling and spending had led him to this undesirable place where Hogarth also shows two ‘sane’ women enjoying the ‘freak show of insanity’ (Sir John Soane’s Museum London, 1733). This is a very important piece in demonstrating public perceptions of mental illness. Page (2014) highlights the roots of contemporary understanding and conceptual approaches to madness, whereby health and morality became intertwined. Drawing on themes of gambling, drinking, and visiting whorehouses all became viewed as part of the experience of mental illness (Page, 2004).

That’s not to say that there wasn’t a positive influence of ‘mad-art’ at least in the art world, in the run up to World War 2. Fole (2015) states that before his death in 1933, a psychiatrist and art historian called Dr Hans Prinzhorn assembled a collection of art by mentally ill patients that was the beginning of what is now known as ‘outsider art’. Once Munch and Van Gogh made mental distress a positive value in modern art, a key to visionary truth, it was only a matter of time before the medical profession too started to see new connections between art and the mind. Hauschild (2013) discusses The Prinzhorn Collection and that today it is today based at Heidelberg's University Hospital, in Germany, where one can see more than five thousand drawings, oil paintings, wood carvings and textile works.

But so too does stigma to schizophrenia, at least in today’s popular imagination. It is noted in The New York Times (Goode, 1998) that many people often relate the state of psychosis to Adolf Hitler as they cannot fathom any other way for a person to commit such heinous crimes. In his

early years, Wehring (2011) highlights that Hitler was also a painter and came into politics only after a rejection from a prestigious Zurich art school. Few people caused such harms as Hitler but it has been widely reported by mental health charities, and health authorities, that those with schizophrenia and more likely to be the victim of crime rather than the perpetrator.

Of course, the irony of Hitler used by Goode (1998) more recently in The New York Times to inadvertently stigmatise those with psychosis is far from the historical truth, and it was ‘mad-people’ and art inspired by schizophrenic art that Hitler in fact chose to dehumanise and outlaw.

Looking back at the early works of Carpaccio, and demonic possession, it would seem that misunderstanding of schizophrenia in art was the least of one’s troubles and the very real seriousness and cause for concern broke out along with World War 2 under the Nazi regime (Haywood Gallery, 1996).

It had been bubbling under the surface in Germany since the 1920s under the callous reasoning of Professor Wilhelm Weygandt. This professor worked at the Hamburg university clinic and for Hitler at the ‘Heidelberg clinic’ specialising in ‘Idiocy and cretinism’ of those incarcerated in mental asylums.

As far back at 1921, it’s been reported that the Prinzhorn collection on ‘mad art’ had ‘annoyed’ Weygandt, but the disturbance didn’t stop there (Hayward Gallery, 1996a) In autumn 1933, Weygandt was dismissed from the Nazi ‘Heidelberg clinic’ for insulting Hitler. But degenerating Expressionistic art within the clinic for Nazi propaganda purposes was continued by Carl Schneider who later became the Scientific Director of the Nazi mental-patient extermination programme (Hayward Gallery, 1996b).

Then, in 1938, there was the exhibition that led to death for many. The Berlin Entartete Kunst exhibition selected artworks by children and mental patients

(cretins and idiots in the Nazi view) and displayed them alongside as analogies of works by modern artists to illustrate their ‘sick minds’. Using the vocabulary of psychiatry, the guide accompanying the exhibition denounces all artists and mental patients as ‘idiots, cretins and cripples’ – and thus in the firing line for sterilisation and imprisonment (Haywood Gallery, 1996c).

The consequences were real and fatal. For example, it is reported by Gayford (2008) that the contemporary painter Gerhard Richter lost his aunt, Marianne, who suffered schizophrenia, under the Nazi regime where she was forcibly sterilised, then later starved to death in a euthanasia camp as part of Hitler’s regime to exterminate the mentally ill. She features in the 1965 painting named after her. Also in The Daily Telegraph Smart (2011) discusses Aunt Marianne and how she was euthanised by the Nazis. In a recent exhibition of the Richter’s work, Uncle Rudi, hangs alongside Marianne – depicting Richter’s uncle, posing proudly in his Wehrmacht uniform, shortly before his call-up to fight – and indeed die – for the regime that would kill off his sister. Richter’s painting is a more tender portrayal of schizophrenia as it depicts a loving scene of woman holding a baby in swathes of cloth – showing that art can have a positive role in how people with schizophrenia can be perceived.

CHAPTER TWO ARTISTIC VIEWS ON SCHIZOPHRENIA ‘Going Goya’

For Craig Jackson, a Professor of Birmingham City University’s psychology department, interviewed in January 2018, the relationship between art and the issue of the artist as the sufferer of a disturbed mind is almost as old as art appreciation and art criticism itself.

Jackson (2018) goes on to say that great art that remains relevant and continues to carry a message about the human condition is often made by

those who experience the harsher edge of the human condition. Although it is something of a common trope to have great art traditionally be the product of an artist who sees the world differently from most other people, there is no doubt that tortured geniuses, who see the world differently from the rest of us litter the art world.

Indeed, according to The Surrealist poet Paul Éluard wrote: ‘We who love them understand that the insane refuse to be cured. We know well that it is we who are locked up when the asylum door is shut: the prison is outside the asylum, liberty is to be found inside’ (MacGregor, 1989). It’s as if madness in the arts is glamorised.

Psychosis, Professor Jackson (2018) also highlighted that psychosis can distort and obscure the sufferers’ views of their world and what reality is, are a form of torture, with many sufferers enduring a lifetime of fear, anxiety, ostracism and difficulty. This is established to the point that great works, from whatever period in time, and whatever style and medium used, often involve the viewer trying to understand the artists’ (suffering) themselves – “what were they going through when they drew this”. Almost like a revisionist pathology – we see the suffering sub-message first rather than the true meaning the artists tried to convey.

For Jackson, (2018) some of the best images that capture the meaning of psychosis – whether it is schizophrenia or another form of departure from reality, come from Goya in his later period.

Jackson says: “As he grew older and feared ageing and madness, Goya’s The Black Paintings (1819-1823) contain some of the most visceral agony of some of his darker pieces, the contorted faces of sufferers of mental disturbance, and the unreal fantasy elements combine to portray a very frightening and scared view of the world.”

As revealed by the professor, Saturn Devouring his Son (Figure 3); Two Old Ones eating Soup; Witches’ Sabbath all convey fear, dread and the madness of losing control of sanity. People engaging in visceral irrational acts in the paintings are not necessarily depicting the behaviour of people suffering psychoses, but more likely that the subjects are reflecting the fears and altered perceptions and hallucinations of terrified sufferers.

However, the dichotomy today, says Jackson is that he finds that art and images created by someone known to be suffering from psychosis or schizophrenia often means that it carries certain expectations with it.

The art becomes secondary to the suffering. The disturbed artist, who we now retrospectively view as suffering from a mental health problem (whereas previously they were labelled as just mad).

According to Filisati (2010) Goya suffered a myriad of ill-health, including subsequent psychological disorders at the time known as depression and hypochondria, and, like all deaf people, became diffident.

Speaking again to Jackson, (2018) about acute mental distress depicted in art we can still some of the archaic pictures of suffering, torment and horror of which Goya is a great example (Jones, 2015). While no-illness is seen as ‘good’, perhaps Goya is not the best example to illustrate acute mental illness and reverting to the original stats of discrimination towards people with schizophrenia in employment, and the

common assumption that

schizophrenia is associated with violence, it is hard to see how the artist Goya’s ‘bloodbath’ can help challenge stereotypes.

CHAPTER THREE SERVICE USER-ART CHANGING PERCEPTIONS OF SCHIZOPHRENIA ‘Diagnosis art’

‘Mad-art’ has changed exponentially, at least for the artist themselves. As artist and mental health campaigner Alice Evans, interviewed in January 2018, has a diagnosis of ‘schizo-affective’ says: “Yes, art has certainly had a big part to play in coping with having a mental health diagnosis.” She states that it has helped her feel part of a social circle again after spending many years where she found it difficult to maintain friendships. It has also given her a present career as an artist and art PhD candidate which has helped her regain the self-confidence lost when she was so unwell.

Evans says: “The biggest issue I find with experiencing psychosis is about my personal narrative or the way I am able to explain myself within the world in terms of my story. Stories are who we are. From the very dawn of humanity, stories are how we understand ourselves and the world.”

Figure 6: Beauti ful Dreamer, by Alice Evans

She says that making her work helps her express some of the difficulties encountered when her own narratives contradict with the narratives of other people because of the experience of psychosis. What she has found is that one of the most challenging aspects to experiencing psychosis is that the stories we tell about our place and experience in the world are disavowed or dismissed as not legitimate experiences (of course they are unreal and very strange but they feel very 'real' to the person who experiences them).

Experiencing an unreal perspective on the world can be very frightening of course Evans says she is very grateful to the NHS mental health services who

help her cope and recover from these experiences. However, it is art for Evans that has been vitally important too as part of a (partial) psychological recovery since it helps her feel her life is meaningful through helping her to tell stories in a form that is acceptable and comprehensible to others.

However, according to Ruiz et al (2017) while art therapy is used as a complementary treatment to antipsychotics in schizophrenia its effectiveness is not clear and its evidence-base is very low (see Figure 7).

Evans (2018) goes on to state that a psychotic experience is a very isolating reality since it is very much an individual perceptive experience which contrasts very much to the experience of those around us. Stories are part of what make us feel valid, connected and human in the world and if our stories tell of ourselves are invalidated because (understandably) they make no sense to others a big part of who we are also makes a person feel very alienated and different from others.

As such, says Evans: “I feel that my artwork, strange though it is produces something from my internal experience that can connect with others and helps me feel part of the world of life stories once again.�

Stories are who we are. Stories are our narratives – one of the most essential part of being human is how people tell their stories. This is who we are. If, through illness, the stories we understand ourselves to be are very different from others in the world (such as when we experience psychosis) it is difficult to feel connected and supported or understood by others. The result is that we may feel very alienated, lonely or alone.

Quite often people who experience psychosis are thought of as being challenged due to the inability to relate within social groupings. There was a recent conference at Exeter University about this (Disturbances in We intentionality in Schizophrenia and Autism conference if you want to look up

the paper online) But actually Evans doesn’t think this is entirely true. She says it is sometimes the experience we have of not being able to connect with others because we have a very different experience of narrative from other people that makes this social connection difficult. It is not always that we don't want to connect but that our narratives of ourselves are disrupted by the illness which makes connection very challenging.

Medication can really help with mental health but without being able to tell our human story it will only ever be a partial life that we lead. And this is what Evans work is all about. It is essentially about telling stories.

Her photographs also express some of the feelings she has of psychosis, particularly the process of depersonalisation which is something she experiences quite frequently. This is when it feels as if the outside world is invading your inside experiences. So Evans makes some of her photographs which express this feeling which show, quite literally, the weather or external world, invading the interior of a house or building.

Quite often in the history of art, the house or home is a metaphor for the human psyche. So in a way, Evan’s images which show the inside and outside of the building in the same image are a little about the experience of depersonalisation. A bit similar to an empty chair around a dinner table being representative of an absent guest.

Figure 8: 'Beach' by Alice Evans which expresses her experience of depersonalisati on.

‘Beach’ a photograph by Alice Evan’s depicts schizophrenia and symptoms of the illness without blood, severed heads or the devil. Instead the image shows what appear to be three healthy men sat on sand around a campfire.

And so, the narrative for schizophrenia and the experiences and symptoms that accompany such a diagnosis are changing.

CHAPTER FOUR THE IMPACT OF ART TODAY ‘Word on the street ’

If the work of Evans and artists like her are able to exhibit a change a scenes of schizophrenia in art, then the essay shall now look at the impact art like Evans may have on the general public.

Data collected from a survey of ninety-one people suggests it does and particularly street art, or art on the High Street, suggesting that people are still very much living in the real world (as opposed to a virtual one).

Those surveyed were derived from 43 people across social media (from 2230 followers) and 48 people from Linkedin (from 640 followers). The cross section was wide ranging with both men and women aged between 18 – 65 and everyone from the unemployed and sickness benefit claimants, to eye surgeons and senior figures in the criminal justice sector. About 80% were UKbased.

Sixty-two people out of ninety-one people surveyed had visited an exhibition within a year, and eleven of them had visited a museum, gallery or exhibition within the last two weeks. No-one surveyed claimed to have not visited a museum, gallery or exhibition in their lifetime. This tells us that the depictions of schizophrenia in art can still influence public perceptions.

Figure 9: Data captured on Survey Monkey

Forty-five people out of ninety had recently seen art in a tangible form – either in a gallery or in the High Street, with only fifteen having viewed their last work of art online on social media, suggesting that art presented in typically archaic surroundings is still relevant.

Only two people of seventy seven suggested that art ‘rarely’ or ‘very unlikely’ changed their view on the world, with the majority of respondents claiming that they’d be very likely to be inspired, moved or educated by a piece of art – time permitted. This would suggest that art still influences people and so depictions of schizophrenia in art can still shape how people think.

Seventy-seven people responded to the question: ‘how likely are you to engage in art, be it a social media ‘like’ or stopping for a minute to appreciate a piece?’ Many respondents wrote at length.

Respondents did not just say they engaged in art, they were inspired to show us how much. For example, one anonymous respondent wrote: “Very likely [I will engage in art] increasingly (as I get older) I want to spend my time and money looking at and collecting great art that has meaning to me. We now seek out a print of price of art from all holidays and trips to ensure the memories are kept alive.”

Another somewhat poetical response to the question solicited this: “Very often [I will engage in art] – I love art, photography and sculpture so if anything catches my eye I will stop whether that is on a high street or social media. I don't visit galleries and museums as often as I'd like to due to availability in my area. But last year visited the Tate Britain to visit a specific installation piece.”

Several of the seventy-seven surveyed said that in particular they felt an affinity with street art or graffiti and often stopped to appreciate it.

CHAPTER FIVE CONCLUSION ‘Escaping the asylum’

If art had the power during World War 2, to imprison, murder and sterilise, surely today it would have the power to change minds and stereotypes today? According to Dr Simon Cross, a lecturer and former trainee psychiatrist at Nottingham Trent University, it can and it does. There is a long tradition of 'schizophrenic art' (as some call it) that does this, he says. At the same time, there are schizophrenics, voice hearers, and so forth who challenge the 'psy' labels (including schizophrenia) with comedy - this is their art. Speaking to Cross he eloquently puts forward the argument that art has the power of

impact to change minds – but wonders if it goes far enough. He says: “Fine or bad art, any art can challenge anything but whether or not it challenges enough to tear down the edifice that labels people 'schizophrenic' (with all that this entails) is anyone's guess.

At this point it is worth revisiting Alice Evans’ interview. An established artist Evans is now doing a PhD in Fine Art at London’s Chelsea College of Art. We can note from the interview how art has had a big part to play in coping with her mental health diagnosis, and of feeling part of a social circle again after a period her illness left her isolated in the past. Evans is now an artist with a career and not just a service user. Through formal education (she also did a BA(Hons) and Master’s degree in Fine Art at Chelsea College of Art) she has not just improved her self-esteem but she also transcends the Outsider and Brut art genres having gained the qualifications and training of a more mainstream artist. She does not just tell us how art can challenge the stigma to schizophrenia, she lives it. She embodies someone who escaped the asylum for greater things.

Traditionally art has not been on the side of the artist – notably in the Medieval Age and during World War 2. However people with schizophrenia are taking art and making it their own – perhaps proving that over time the pen is mightier than the sword. From the survey of ninety-one psychiatric laymen, and their majority feelings of inspiration towards art, it is also quite safe to conclude that even in a digital age, art still has influence and currency among people from all walks of life. This means that when an artists (with or without schizophrenia) creates a depiction of schizophrenia for public perusal, it can and does have an influence on people’s perceptions of what this thing called schizophrenia is.

A lot has changed since Don Quixote’s era. As far as artistic portrayals of schizophrenia, work is being done by service users and artists like Evans to

change the narrative. And as the survey showed, art does have the power to change the public perception of severe mental illnesses like schizophrenia.

Ends

ARE ALL ARTISTS ‘MAD’?

ABSTRACT

Many papers have written about creativity and mental illness, and whether mental illnesses can improve creativity (Waddell, 1998). This report aims to address this conundrum. Furthermore, according to Waddell, there are limited scientific papers that evidence an association between creativity and mental illness. More contemporary opinion from artists who work with schizophrenia (Evans, 2017) conclude that to associate the two is actually “silly”. However, while the link between mental illness and creativity is currently unknown by science and the arts, it is established by service users that art can play a role in helping people with their recovery from a severe mental illness. According to service user artist Harding (2015) writing in The Lancet Psychiatry, art has not just helped with his own recovery but it has enhanced his own art practice by giving him very real experiences other people may not have had in their lifetime. Art also, by expressing the very real human plight and suffering, can make a person feel less alone in their own sufferings and/or mental distress (Stuart, 2018).

INTRODUCTION

For every Van Gogh there are a significant number of people (Official National Statistics, see table below) inflicted with a severe mental illness (by ‘severe’ the author means ‘using secondary care services’) who are not famous artists or creative professionals. Despite this, there’s still interest and inspiration

drawn from artists producing work while at the same time suffering from a mental illness (Rexer, 2005).

MAIN SECTION

This section explores artists with, and artistic expressions of, severe mental illness. A quick search of ‘mental illness and creativity’ on Google Scholar will bring up many papers exploring the theme. There are also many books that argue for and against the case for mental illness improving creativity, or the phenomena of ‘Outsider and Brut art’. However not all art produced by mental patients has value (Ebay, 2018). But it is said by patients with severe mental illness that producing artwork can derive inspiration from the darker emotions (Harding, 2015) as well as assist a patient in their recovery (Evans, 2017). It is also stated by Stuart (2018) that artworks such as film can help people locate and relate their own suffering and difficult experiences with the lives of others.

HISTORY ‘Madness’ has set people back since it’s been misunderstood during Medieval times, when mental illness was seen as demonic possession (Vittore Carpaccio’s 1496). Indeed according to the Van Gogh Museum (2016) and also Jones in The Guardian (2016) mental illness inhibits peoples artists abilities, rather than enhancing them.

Even during the age of Enlightenment, William Hogarth’s ‘The Rake in Bedlam’ is perhaps the best known painting of the period which depicts mental illness (Jones, 2015). Also known simply as The Rake, the painting shows us the roots of misunderstanding to mental illness, whereby health and morality mix, with themes of gambling, drinking, and visiting whorehouses all became viewed as part of the experience of mental illness (Page, 2004).

SUICIDE Perhaps the biggest drawback for people diagnosed with severe mental illness is the suicide statistics. Looking at schizophrenia as an example, according to a study by Palmer et al (2005) people with schizophrenia have a 5 to 10% chance of dying by their own hand within ten years of diagnosis and, according to Caldwell et al (1992) around two and half times higher than the general population.

In the frame of the arts, according to Stylist Magazine (2018), it is noted that one of the most cited Shakespearean quote all the world over:

Hamlet "To be, or not to be; that is the question; Whether 'tis nobler in the mind to suffer; The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles" Act 3, Scene 1 The theme of suicide is elaborated on by Albert Camus in the Myth of Sisyphus (1942) some centuries later. In Camus’ essay on suicide he raises the point that for a person to ask themselves: “Is my life worth living,” is the most fundamental question of philosophy we can pose to ourselves. Noting this alone can be empowering to a person with schizophrenia as it makes less of a victim of the person with a mental illness, and instead sets them out more as a philosopher (Camus, 1942).

VAN GOGH One well-known artist who fell victim to suicide was Van Gogh. There was an exhibition a couple of years ago called ‘On the Verge of Insanity’ at the Van Gogh museum in the Netherlands that explores the artist’s mental illness through his works and letters. It expelled the myth of the ‘creative genius’ and

put forward the arguments that Van Gogh succeeded as an artist in spite of his severe mental illness, and not because of it (Van Gogh Museum, 2016).

Jones (2016) reports in The Guardian that in letters from Van Gogh to his brother Theo he broods more than once on an 1872 painting by Emile Wauters called The Madness of Hugo van der Goes, which shows the 15thcentury Flemish painter as a victim of mental illness.

ART & SUFFERING It is not just fine art that details suffering from the prism of mental illness. Art of all kinds - literature through to performance art – informs us how our ancestors not just lived but also felt and can often reveal the secret dialogue we all have with ourselves at different stages in life. It can help us feel less alone in the dark. For example Akutagawa's suicide note in The Life of a Stupid Man (1927). In his book Akutagawa goes into detail about his life and subsequent feelings living with a mental illness which we now know as depression. Reading especially about the lives of others helps people come to terms with - to cite British-Indian author Myra Syal – their lives and suffering.

For example the title of her 1999 tome 'Life isn't all ha ha he he'.

Suffering and mental distress are no better depicted than in Edvard Munch’s ‘Scream’ (1893) – a piece people might relate to at various stages in their lives. As Pitman (2011) notes in The British Journal of Psychiatry: “Edvard Munch is best known for The Scream, 1893, an image endlessly reproduced in the media to depict mental anguish. Explanations of the meaning behind the image abound, mainly focusing on an outpouring of emotion in response to suffering. Munch’s own explanation is revealed in his diaries, which recall the melancholy of a walk along a bridge with friends. Trembling in fear at the fiery sunset, he sensed ‘how an infinite scream was going through the whole of nature’. This dehumanised figure, into which viewers project their own neuroses, is not screaming but blocking out the scream of its existence.”

There's colour and life that will always endure each and every fate, like in the case of the Italian painter Caravaggio, who according to Prose (2010) had his renaissance centuries after he'd retired to the heavens from a subsequently botched and traumatic life.

In an interview with Clinical Psychologist Simon Stuart (2018) “It’s easier to think of films that get severe mental illness badly wrong – Unsane is a recent, rotten example that springs to mind! But one film that I think deals beautifully with two pertinent psychological issues – the desire we have as human beings for love (and how difficult that can be), and the desire we have to get rid of emotional pain – is Eternal Sunshine Of The Spotless Mind (Michel Gondry, 2004). It's a film about what it is to be human, in short; to be both blessed and cursed with the ability to think, and relate, and remember.

It is a beautiful piece of work”.

SERVICE USER PERSPECTIVES According to Harding (2015) it is established that art can play a role in helping people with severe mental illness recover. The artist states in The Lancet Psychiatry (2015) that his experiences of mental health have changed his art for the better. He says he has more experiences to draw from and he has experienced things that most people may not touch on in a lifetime. Even though he found it hard at times, he says: “I do think my illness is a blessing as it gives me new insight into what it is to be alive and human. It also lets me experience a broader spectrum of perception. I find the different ways the mind can perceive the world fascinating. It gives me a glimpse of what reality truly is. I feel I have resolved the past as much as I can, and have moved on from what has happened. This has been due to moving back to Bristol, with family and friends close by, and a great support network that includes the Bethlem Gallery. I have also stopped using drugs and have been having hypnotherapy and doing meditation, which has helped resolve destructive patterns of thinking and behaviour.”

BRUT ART Art and mental illness can sometimes sit hand in hand and there is no better case for this than The Prinzhorn Collection which actually takes inspiration and the art itself from patients of a mental asylum. Based at Heidelberg's University Hospital, in Germany, The Prinzhorn Collection holds more than five thousand drawings, oil paintings, wood carvings and textile works (Hauschild, 2013) all painted or produced exclusively by mentally ill patients.

According to Fol (2015), this type of art sits within the art world as ‘Outsider art’ or ‘Brut art’ standing for all that is raw and untrained and socially excluded.

If the Prinzhorn Collection was all about outsiders and raw, untrained art, it would take an art insider to champion it (Rexer, 2005). By the turn of the 19 th Century Surrealist established artists Max Ernst (1891-1976) and Henry Rousseau took great inspiration from the Prinzhorn Collection and from work by mentally ill patients. They also took inspiration from Freud and Jung – eminent psychoanalysts at the time, concerned – much like the Surrealists – by dreams and the subconscious (Gallery label, 2008). With inspiration derived from the mentally ill, and the subconscious, Avant-guard playwright Alfred Jarry declare it the antidote to convention (Rexer, 2005).

Another more recent artist promoting the work of mentally ill people was Jean Dubuffet. According to The Tate Museum, Jean Dubuffet saw fine art as dominated by academic training. For him, ‘Art brut’ included graffiti, and the work of people with mental illness (among others) as a vision or emotions, outside of convention or academic artist interpretations. The art of the mentally ill inspired his own practise and he was considered a master to many during his time. He made a large collection of art brut, and promoted its study.

However, it may also be worth noting that ‘Brut’ or ‘Outsider Art’ today has little value other than the reading of it or what has been held as ‘good art’ by artists like Ernst and Debuffet of the establishment. Sales for Brut art or art

produced by a person with bipolar of schizophrenia on a mainstream market place such as eBay.co.uk are very low, many pieces starting from just one pound and many looking not unlike a school child’s drawing attached to their parent’s fridge.

A recent off ering of Outsider art on eBay.co.uk

CONCLUSIONS

Art in all its guises has historically shed light on darkness for those with and without mental illness to see and relate to. But it has also stigmatised both artist and patient for example the picture titled The Rake’s Progress by Hogarth. For Van Gogh his art didn’t save him from the outlined suicide stats, though for artists working around severe mental today, such as Evans and Harding, it is said it can aid their recovery.

There is limited scientific evidence to associate creativity with mental illness, but there is also evidence on ebay and in books on Brut art that the art produced by mentally ill persons only sells or is of value if it’s been upheld by an established ‘art insider’.

As Evans notes in her Metro article (2017), being an artist doesn’t make her more creative or superior to artists without mental illness. However, what she goes on to conclude is that art and working with artistic expression does help her manage her own severe mental illness.

Art can also help people by expressing the very real human plight and suffering that can make any person feel less alone, as in Stuart’s (2018) assentation on The Eternal Sunshine of the Spotless Mind (2004).

REFERENCES ASHOK, H (2012) ‘Paul Eugen Bleuler and the origin of the term schizophrenia (SCHIZOPRENIEGRUPPE)’ The Indian Journal of Psychiatry, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339235/ (accessed 19th February 2018) BEVERIDGE, A (2001) ‘A disquieting feeling of strangeness?: the art of the mentally ill’ The Journal of The Royal Society of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282252/#ref2 (accessed 27th March 2018) BORRAS, L, MOHR, S, BRANDT, P.Y; GILLIERON, A (2007) ‘Religious Beliefs in Schizophrenia: Their Relevance for Adherence to Treatment’ Schizophrenia Bulletin https://academic.oup.com/schizophreniabulletin/article/33/5/1238/1895600 (accessed 27 March 2018) CALDWELL, C; GOTTESMAN, I (1992) Depression, Suicide and Suicide Prevention in Schizophrenia, Schizophrenics Kill Themselves Too, Schizophrenia Bulletin, https://academic.oup.com/schizophreniabulletin/article/16/4/571/1936618 (accessed 29th April 2018) CROSS, S (2010) ‘Mediating Madness’ DE CERVANTES (1602) ‘Don Quixote’ FAZEL, S (2008) ‘The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis’ PLoS Med https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592351/ (accessed 19th February 2018)

FOL, C (2015) ‘From Art Brut to art without boundaries’ pg 11 GAITE, L ET AL (2002) ‘Quality of life in patients with schizophrenia in five European countries: the EPSILON study’ Acta Psychiatrica Scandinavica, 105, 283 -292 GALE, C (April 2014) ‘Bethlem Museum of the Mind Archive’ http://archives.museumofthemind.org.uk/photos.htm (accessed 27th March 2018) GALLERY LABEL (2008) ‘Max Ernst’ http://www.tate.org.uk/art/artworks/ernst-men-shall-know-nothing-of-thist00336 (accessed 26th April 2018) GAYFORD, M (2008) ‘Gerhard Richter: behind the pictures’ The Daily Telegraph http://www.telegraph.co.uk/culture/art/3561020/Gerhard-Richter-behindthe-pictures.html (accessed 19th February 2018) GOMBRICH, EH (1950) ‘The History of Art’ pg 40 GOODE, E (1998) ‘Insane or Just Evil? A Psychiatrist Takes a New Look at Hitler’ The New York Times, http://www.nytimes.com/1998/11/17/science/insane-or-just-evil-apsychiatrist-takes-a-new-look-at-hitler.html (accessed 19th February 2018) HARDING, G (2015) The Lancet Psychiatry ‘A labour of love’ http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)005027/fulltext (accessed 23rd February 2018) HARDING, G.J (2014) ‘About’ http://www.georgejharding.co.uk/about/ (accessed 27th March 2018) HAUSCHILD, J (2013) ‘Psychiatric Breakthrough When Illness Inspires Great Art’ Spiegel Online HAYWARD GALLERY (1996a) ‘Beyond Reason, art and psychosis works from the Prinzhorn Collection’ – pg17 ch 6 HAYWARD GALLERY (1996b) ‘Beyond Reason, art and psychosis works from the Prinzhorn Collection’ – pg18 ch 6 HAYWARD GALLERY (1996c) ‘Beyond Reason, art and psychosis works from the Prinzhorn Collection’ – pg 19 ch 2

HAUSCHILD, J (2013) ‘When Illness Inspires Great Art’ Spiegel Online http://www.spiegel.de/international/zeitgeist/masterpieces-from-theprinzhorn-collection-by-psychiatric-patients-a-936148.html (accessed 19th February 2018) JONES, J (2015) ‘A short history of mental illness in art’ The Guardian https://www.theguardian.com/society/christmas-charity-appeal-2014blog/2015/jan/13/-sp-a-short-history-of-mental-illness-in-art (Accessed 19 th February 2018) JONES, J (2015) ‘Goya in hell: the bloodbath that explains his most harrowing work’ The Guardian, 4th October [online] Available at: https://www.theguardian.com/artanddesign/2015/oct/04/goya-in-hellnational-gallery-portraits (accessed 19th February 2018) MACGREGOR, J; ‘The Discovery of the Art of the Insane’. Princeton: Princeton University Press, 1989 ONS (2017) Statistics for British Mental health Service Users, https://fingertips.phe.org.uk/profile-group/mental-health/profile/severementalillness/data#page/0/gid/1938132719/pat/46/par/E39000030/ati/152/are/E3 8000010/iid/90420/age/208/sex/4 (Accessed 26th April 2018) PAGE, D (2014) ‘Changing Conceptualisations of Mental Illness and Exclusion: Revisiting the concept of Stigma? University of the West of England, Bristol (PDF accessed 27th March 2018) PARMER, B; PANKRATX, V; BOSTWICK, J (2005) The Lifetime Risk of Suicide in Schizophrenia, Mayo Clinic, https://mayoclinic.pure.elsevier.com/en/publications/the-lifetime-risk-ofsuicide-in-schizophrenia-a-reexamination, (accessed 29th April 2018) PINTO, C (2007) ‘Don Quixote’ British Medical Journal https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072031/ (accessed 19th February 2012) PITMAN, A (2011) Edvard Munch (1863 – 1944) The Scream, The British Journal of Psychiatry, https://www.cambridge.org/core/journals/the-british-

journal-of-psychiatry/article/edvard-munch-18631944-thescream/423651E7272FBE8524BD91F3E8233E82 (accessed 29 April 2018) PROSE, F (2010) ‘Caravaggio: Painter of Miracles (Eminent Lives) Paperback’, Harper Collins REXER, L (2005) ‘How to look at Outsider art’ SECKER, J, ET AL (2001) Challenging barriers to employment, training and education for mental health service users: the service user's perspective.

Journal of Mental Health, 10, 395 -404.

SIR JOHN SOANE’S MUSEUM LONDON (1733) ‘The Rake’s Progress’ Soane.org https://www.soane.org/collections-research/key-stories/rakes-progress (accessed 19th February 2018) STYLIST REPORTER (2018), ‘Shakespeare’s Most memorable Quotes’, Stylist Magazine, https://www.stylist.co.uk/books/shakespeares-most-memorablequotes/123652, (accessed 29th April 2018) VAN GOGH MUSEUM, (2016) Van Gogh’s Life, https://www.vangoghmuseum.nl/en/stories/on-the-verge-of-insanity#2 (acce ssed 26th April 2018 WADDELL, C (1998) Creativity & Mental Illness: Is there a link? The Canadian Journal of Psychiatry, https://doi.org/10.1177/070674379804300206 (accessed 26th April 2018) WEHRING, J.J; CARPENTER (2011) ‘Violence and Schizophrenia’ Schizophrenia Bulletin, https://doi.org/10.1093/schbul/sbr094 (accessed 27th March 2018)