American Journal of Orthopsychiatry 2005, Vol. 75, No.

2, 171–189

Copyright 2005 by the Educational Publishing Foundation 0002-9432/05/$12.00 DOI: 10.1037/0002-9432.75.2.171

Interior Landscapes of Mental Disorder: Visual Representations of the Experience of Madness
Thomas J. Schoeneman, PhD, Carly M. Henderson, MA, and Vaunne M. Weathers, MS
Lewis and Clark College
The authors surveyed 38 textbooks of abnormal psychology and found 673 pictures of the inner experience of mental disorder. Textbook authors use these pictures to demonstrate diagnostic features of individuals and groups, to make a connection between mental disorder and artistic talent, and to suggest what it is like to experience mental disorder. To fulfill these functions, many of the pictures in the sample use the incongruities and distortions of expressionist, surrealist, and naive techniques.

Psychologists and psychiatrists who study stereotypes of mental illness have shown that stigmatizing attitudes toward the mentally ill are widespread and harmful (Corrigan & Penn, 1999). Investigators in this area have tried to counter this prejudice, in part, by describing the contents of stereotypical beliefs about the mentally ill. This work initially focused on public opinion. Rabkin (1972), for example, found that public attitudes consistently characterize the mentally ill as unpredictable, dangerous, and not responsible for their actions. Later investigators turned their attention to media depictions, confirming the presence of these negative attitudes in plots and characterizations (Gerbner, Gross, Morgan, & Signorelli, 1988; Wahl, 1992) and adding descriptions of recurrent narrative themes that feature mentally ill characters as rebellious free spirits, enlightened outsiders, homicidal maniacs, narcissistic parasites, and dehumanized asylum inmates (Hyler, Gabbard, & Schneider, 1991). A third component of stereotypes of madness involves visual elements: There are common and recurrent visual depictions of both the outer appearance and the inner experience of insanity. Visual stereotypes have occasionally been noted by social scientists (e.g., Scheff, 1966), but they have been studied
Thomas J. Schoeneman, PhD, Carly M. Henderson, MA, and Vaunne M. Weathers, MS, Department of Psychology, Lewis and Clark College. An earlier version of this research was presented at the meeting of the Western Psychological Association, April 1997, Seattle, Washington. For reprints and correspondence: Thomas J. Schoeneman, PhD, Department of Psychology, Lewis and Clark College, 0615 Southwest Palatine Hill Road, Portland, OR 97219. E-mail:

systematically by historians (Gilman, 1982, 1985, 1988; MacGregor, 1989). Our focus in this article is on visual stereotypes, particularly on the contents and implications of depictions of what it is like to be mad. We begin by briefly describing stereotypes of the external appearance of the mentally ill and then turn to a more extensive survey of two trends in the artistic representation of the inner experience of madness.

Interior Landscapes of Mental Disorder
The maniac, the melancholic, and the fool are recurring figures of external appearance in medical, artistic, and popular conceptions of mental disorder over the course of Western history (Gilman, 1982; Schoeneman, Brooks, Gibson, Routbort, & Jacobs, 1994). Depictions of the active madness of the maniac feature wide eyes and an open mouth, a contorted body posture, disheveled hair and clothes, full or partial nakedness, and restraints. The melancholic is generally presented in the pensive philosopher’s pose—seated, eyes downcast, head in hands—with face and figure in at least partial darkness. Depictions of folly often combine aspects of maniacal madness or melancholy with silly or vacant facial features, incongruous clothes, and such props as a fool’s staff, pinwheel, or balloon. Other visual features, such as the staff of madness or hidden hands, can be present in depictions of all forms of madness. In the past 150 years, the catalog of visual stereotypes of madness has expanded beyond portrayals of appearance to include depictions of the experience of mental disorder (Gilman, 1982, 1985). Using a metaphor borrowed from art, we call this type of picture interior landscapes of mental disorder. Two kinds of depictions of the inner world of madness have be-


Among these critics were psychiatrists who assigned diagnoses to noted artists on the basis of analyses of their paintings and sculptures. in many cases. orange sky in Edvard Munch’s The Scream (1894). whereas the Collection de l’Art Brut. tilted frames. As a result. The bodies of work that produced these depictions of disordered mental processes bear an interesting relationship to the art of the mentally ill. the melting clocks and barren sands of Salvador Dali’s Persistence of Memory (1931). analyzed. are now a part of everyday popular culture. Gilman (1982) noted the continuing presence of these stereotypes in many of the pictures in a modern textbook of psychiatry. megalomania. but they were nevertheless influenced by its interest in the inner world of the genius. 1919). psychiatrists and artists alike began to take greater interest in the art of the insane. which had until that time been discouraged and ignored in asylums. 1982). 1989. the artist. now in Lausanne.172 SCHOENEMAN. including their interest in the depiction of emotional states and disordered mental processes. artistic products of asylum inmates came under close scrutiny. cartoons. and artists’ renditions of disordered mental processes. 1989). and the madman. Gilman also observed. Psychiatrists of the late 1800s did not share the Romantic distrust of reason and sanity. The first stage in the emergence of interest in interior landscapes of mental disorder began in the middle 1800s. The second trend in the depiction of the inner world of the mentally disordered involved professional artists’ depictions of mental states in general. In particular. 20th century artists. Visual references to mental disorder that include blurred images. alongside depictions of tradi- . At the beginning of the 20th century. 1985. dementia. hospitalized amateurs such as August Klett and Adolf Wo ¨ lfli were hailed as “schizophrenic masters.” By the middle of the 20th century. A confluence of 19th century Romanticism and moral psychiatry spurred interest in the art of the insane as a window into the phenomenology of madness (Gilman. but one common result of many of these agendas was the visual exploration of interior experiences such as emotional states. As James MacGregor (1989) has noted. and collected. and the representation of a madman’s delusion through the use of distorted sets and unconventional camera angles in the German Expressionist film The Cabinet of Dr. 350). Under the influence of Romanticism. HENDERSON. Sander L. MacGregor. 1989). could be used to understand the ways that individual patients constructed their realities. and psychiatrists often proceeded in their endeavors with a superficial understanding of each others’ disciplines. and psychology textbooks. MacGregor. which resulted in “a considerable amount of amateurish and naive ‘psychologizing’” (p. owes its existence to the artist Jean Dubuffet (Gilman. a historical survey of stereotypes of the external appearance of the mentally ill. and the like— often occurring in conjunction with stereotypic pictures of external appearance—are now commonplace in such diverse locations as horror movies. art movements such as Expressionism and Surrealism abandoned the goal of faithful representation of external reality (Gilman. they considered madness to be a heightened state of awareness that was. dreams. Romanticists were fascinated with the inner emotional life of the passionate. then. AND WEATHERS come standard: the artistic products of mentally ill individuals. the respected psychiatrist Ambroise-Auguste Tardieu suggested that the artistic productions of the insane. uncanny settings. 1989). Later in the same decade. Prinzhorn. core self. 1922/1995). MacGregor. Expressionists revered van Gogh and viewed his mental illness as crucial to his greatest paintings. Iconoclasts in modern art movements were keenly interested in works produced by the insane. 1985. Caligari (Wiene. What is ironic about this history of revolution and reaction is that the visual ideas of modern art movements. pharmaceutical ads. art historians. two great collections of the art of the insane had been established: The Prinzhorn Collection in Heidelberg bears the name of the psychiatrist who founded it. magazine illustrations. Paul-Max Simon suggested that patients’ art could be used in the differential diagnosis of melancholia. Outraged critics reacted to modern art by questioning the sanity of its practitioners. “Schizophrenic art” in particular began to be encouraged. and psychopathology. general paralysis. 1985. Well-known examples include the anxiety suggested by the turbulent. whereas Surrealists proudly emulated works produced by inmates of insane asylums. in tandem with Freudian psychoanalysis and sometimes under its direct influence. allied with genius and creativity (Kessel. In 1872. chronic mania. Each school had its own revolutionary ideals. The Uses of Interior Landscapes of Mental Disorder In the epilogue to Seeing the Insane. The lives and works of trained artists such as Richard Dadd and Vincent van Gogh were used to validate the conception of the mad genius. and imbecility (Gilman. 1982. At the same time.

the analyst may venture interpretations based on the form and content of artistic works. MacGregor. The caption refers to the fact that “paranoid patients are often unable to separate the thought from the deed and fear that their angry impulses can kill others or themselves. During this time.INTERIOR LANDSCAPES OF MENTAL DISORDER 173 tional stereotypes of exterior appearance. Jamison. MacGregor. Kessel. Nevertheless. to understand the psychology of individual artists. Today. Gilman’s commentary raises an interesting question: Why are interior landscapes of mental disorder “not only accepted but expected” (p. Schoeneman & Marley. 1985. and the mass media (Gilman. Diagnosis. and to illustrate the subjective experience of madness. should be established independently. such as the artist’s life situations. MacGregor. The concept of the mad genius—an umbrella that covers not only practitioners of the visual arts but also poets. see the psychological analysis of art as useful in illuminating individual symbol systems (Gilman. 1989. 1987.. Cesare Lombroso’s late 19th century use of paintings and drawings to illustrate moral degeneracy in both criminals and geniuses. therapist influences. 224) Gilman (1982) noted that many of these pictures offer a combination of both the “external aspect of the patient” and “his mental life and history. Once this thorough assessment is in hand. musicians. 1985) but also caution that this project can only be undertaken with great care. 1989). Kraepelin’s (1921) suggestion that manic episodes of bipolar mood disorders disinhibit and enhance artistic cognitions and behaviors has modern proponents who claim empirical support (e. . Art produced by mentally ill individuals and by professional artists who aim to simulate disordered mental processes has appeared with increasing frequency over the last century in gallery exhibitions. the analyst must have a thorough knowledge of art history and a comprehensive grasp of relevant external factors. professional publications. All three of these functions have turned out to be problematic. the reader is presented with an image of the dismembered body of a clothes mannequin lying on an open space. more broadly. This is a far cry from the earlier agenda of mapping artistic elements to specific diagnostic labels and mental processes. this combination is not only accepted but expected” (p. to demonstrate a connection between mental illness and creative genius. 1989).” In another. the hypothesis of a connection between mental disorder and creative genius remains controversial. . 224). 1989). From Tardieu and Simon in the 1870s to Prinzhorn (1922/1955) in the 1920s to the present day. 224). the picture of a female hugging three children while a male sits apart in the background illustrates “a patient’s relationship to his parents and siblings. and a reintegration into society of the mentally ill (e. 224) in textbooks of psychiatry and psychology? Our brief history of interior landscapes of mental disorder suggests that mental health professionals have found three uses for this type of art in the past 150 years: to diagnose varieties of mental disorder and.g. 1989). even if images of the internal world of the mentally ill are intended to . current and past artistic conventions. with two minuscule figures running in the background. Mental health and art professionals alike have used these images to depict the subjective experience of mental disorder for lay audiences. novelists. “an entirely new area of perception” (p. and scientists—is at least as ancient as Plato and Aristotle (Gilman. mental health professionals have disagreed about whether artistic products have diagnostic usefulness. 1982. followed a few decades later by the Nazis’ identification and suppression of degenerate art and artists. if relevant. arguments that mental disorder in general decreases artistic output.” (p. 1994). The use of art to demonstrate a connection between madness and creative genius has often occurred in conjunction with the diagnostic function in the past 150 years. 1989). 1985. MacGregor. erudite tradition of Hans Prinzhorn and Ernst Kris. In teaching aids today. Andreasen. acceptance. Opponents of the bipolar hypothesis have countered with demonstrations that mania increases the quantity but not the quality of works produced. and a suggestion that the madness– genius connection is nothing more than one of many prevalent stereotypes of mental disorder (Kessel.g. Modern psychodynamic observers of art. However. He gave two examples: In one instance. and relevant cultural stereotypes of depicting different types of individuals and mental processes. Those who affirmed the utility of art in understanding the psychology of the artist suffered notable embarrassments—for example. 1989. . A casual look at two or three textbooks of abnormal psychology easily confirms Gilman’s (1982) observation: Pictures of disordered psychological processes as well as pictures produced by mentally ill individuals are easy to find. in the careful. 1995. the history of attempts to correlate artistic elements with diagnostic categories has been full of controversy and frustration (Gilman.. Some observers applaud the proliferation of interior landscapes of mental disorder as having the potential to promote understanding. Weisberg.

We coded the initial sample of 7. Interior landscapes of mental disorder often contain aspects of exterior appearance—think. process versus product—with an interrater agreement of 97%. Our studies of pictures of the exterior appearance of the mentally ill that have appeared in textbooks of abnormal psychology in the last 20 years have shown us a sufficient number of interior landscapes of mental disorder to confirm Gilman’s (1982) earlier sightings and pique our interest. 93%). All disagreements were resolved through discussion. interior mental processes. illustrated letters). or the Romantic idea of “insanity as a marvelous state of creative freedom and unrestrained imagination” (MacGregor. for instance..g. Schoeneman as the final arbiter.g. we needed a source of such pictures. with Thomas J. and we inspected pictures and captions to interpret the implicit and explicit messages that they contained.174 SCHOENEMAN. creativity. Although we have focused so far only on artworks as products of mental disorder. and genius. boundaries can be fuzzy.7 interior landscapes of mental disorder per textbook (SD ϭ 11. The remaining 69% of the sample. two other types of artifacts can also fit into this category: drawings produced as a part of directed psychological assessment.g. The empathic function uses both process and product pictures as ways of representing what it is like to experience mental disorder. 1989. As this example suggests. There were 207 process pictures (31%). or both. 98%) and diagnosis (26 categories. 1995). the mentally ill. directed drawing). with an agreement rate of 95%. The diagnostic function uses artistic products to classify and understand the unconscious processes of the artist.229 pictures as depicting exterior appearance. HENDERSON. p. Pictures rated as products were further categorized as art (e. Sample Characteristics Our sample yielded an average of 17. As is the case with many conceptual distinctions. process and product pictures are not always clearly separable: A reproduction of Edvard Munch’s The Scream could serve as a depiction of the experience of anxiety or as an example of a work produced by a mentally disturbed artist. 1972). Henderson and Vaunne M. with an interrater reliability of 98%.. results of formal assessment (e. & Gibson. We also suggest three uses of interior landscapes of mental disorder. The commonality between process and product pictures lies in their use as windows into the psyches of a particular class of the Other. . the distinction between process and product pictures often depends on the way that a picture is used by its exhibitor (Berger.g. We then coded each of the 673 pictures that depicted interiority on a number of dimensions. Content Analysis Our sample of pictures came from all 38 textbooks of abnormal psychology published in the United States between 1986 and 1996. Carly M. 673 (9%) are included in our sample of interior landscapes of mental disorder. Of these. Interior landscapes of mental disorder appear in two varieties: Process pictures are professional artists’ simulations of the inner experience of disordered mental processes. range ϭ 2– 43). Brooks. drawings and paintings). of a van Gogh self-portrait or a photograph of a person looking at a distorted reflection in a mirror. Seeing Into the Insane in Textbooks of Abnormal Psychology Let us summarize our argument and propose a terminology for use in the rest of this article. All process and product pictures were coded for psychological status (normal vs. These books contained 7.. and writing samples. reduced via combination to 18 for this report. AND WEATHERS promote empathy.4. In this report. figure copying. Their percentage of agreement was our estimate of interrater reliability. they may function in the same way as depictions of the external appearance of madness by emphasizing the difference of the mentally ill and the distance between the disordered and the normal (Gilman. 1982). To study interior landscapes of mental disorder. Weathers independently sorted each picture into a number of predefined categories (Schoeneman.229 pictures of people’s external appearance or interior experience. writing samples (e. 282). copies of letters).. or mixed (e. Purveyors of internal landscapes of mental disorder could also inadvertently promote degeneracy theories. we turn our attention for the first time to pictures of the interiority of mental illness in these textbooks to answer questions about their prevalence and characteristics. and product pictures are works produced by mentally disturbed individuals. the mad artist stereotype. First we determined interior picture type—that is. whereas the madness– creativity function uses these artifacts as evidence of a connection among mental disorder. In addition. abnormal. Our methodology is both empirical and interpretive: We derived our sample and coded pictures using content analytic procedures.

paranoia. we find Vincent van Gogh to be foremost: His work appears 12 times in our sample. and depersonalization) and were predominant for anxiety disorders. process (2) Process (3) Process (35) Note. 5 times). Originators. paraphilias and transsexualism. Table 1 also lists the dominant picture types for each diagnosis. including most prominently Self-Portrait With Bandaged Ear (1889. Assess- ment products were by far the major picture type for organic brain syndromes and mental retardation and were nearly absent from all other categories except childhood disorders. In the seventh work. epilepsy (1 time). Furthermore. childhood psychosis. An overwhelming majority of these pictures represented abnormal psychological processes (f ϭ 620. Diagnostic Features Table 1 gives frequencies associated with various diagnostic categories. fugue. amnesia. Three quarters of these pictures were artistic products. writing (10). are used to show the exterior appearance of this mad artist as filtered through his own disordered mental processes of bipolar disorder (5 times).INTERIOR LANDSCAPES OF MENTAL DISORDER 175 the product pictures. DID ϭ dissociative identity disorder. An alternative way to describe the diagnostic features of our sample is to look at which disorders are characteristic of each picture type. process (10) Process (40) Art (22) Process (32) Process (11). 80 depictions of assessment drawings (12%). schizophrenia (1 time). Finally. Turning first to originators whose artworks are used to represent their disorders. and dissociative disorders other than dissociative identity disorder (i. Process simulations were exclusively used to depict possession states. six are self-portraits. personality disorders. interior landscapes of schizophrenia and other psychoses were the most frequent in our sample (146 pictures. somatoform disorders. Art was the most prevalent picture type in 10 diagnostic categories.e. included 322 artworks (48% of the total sample). writing (6) Art (9) Process (7) Art (7) Art (3). especially for schizophrenia. . These works. Several features of this catalog deserve comment. art (10) Art (12) Process (16) Art (7). 54 writing samples (8%). 8 of these were attributed to schizophrenics. 138 of these depicted schizophrenia). Written products were predominant for no disorder category but were encountered with some frequency for mood disorders. Works. OBS ϭ organic brain syndrome. a Numbers in parentheses indicate frequency of picture type. 92% of the sample of 673 pictures). and Collections Table 2 presents originators of interior landscapes of mental disorder whose works appeared 5 or more times in our sample. or an unspecified disorder (4 times). of the seven different van Gogh paintings we encountered. Figure Table 1 Diagnostic Categories Represented by Interior Landscapes of Mental Disorder Disorder Schizophrenia/psychosis OBS/mental retardation Childhood disorders Other/not specified Mood disorder Possession Multiple personality/DID Anxiety disorders Addictive disorders Stress-related disorders Other dissociative disorders Paraphilia/transsexualism Diagnosis open Personality disorders Paranoid disorders Eating disorders Somatoform disorders Normal Total 146 78 67 64 41 40 38 35 21 18 16 14 13 11 9 6 3 53 % of sample 22 12 10 10 6 6 6 5 3 3 2 2 2 2 1 1 0 8 Prevailing picture typea Art (108) Assessment (63) Art (43) Art (57) Art (19).. the well-known The Starry Night (1889. By a wide margin. and nondisordered subjects. 9 of the 10 pictures in the mixed category were art and writing combinations. and 10 art– writing mixtures (1%). 22% of the sample. and childhood disorders. and unspecified disorders.

1 assessment Art Art Art Representative work Self-Portrait with Bandaged Ear. 1995). (PC) Rooster (autist savant) Mechanical boy (autism) Cat series (psychosis) Exorcism scene Depictions of phobias St. . Several of these masters are included in Table 2: August Klett. drawings by autistic children (Nadia. The relative predominance of these mentally disordered masters in our sample can be gauged by the frequencies of pictures supplied by the Prinzhorn Collection (f ϭ 38) and the Collection de l’Art Brut (f ϭ 47). Catherine Exorcising a Possessed Woman (see Figure 7) Three-faced portrait of DID alters (see Figure 6) Donna and the Disasterettes Portraits of DID alters The Scream. Franz Karl Buhler. Taken together. The Starry Night (see Figure 1) St. 1 art Art Art Art Art Art Process Process Art Art Art Art Assessment Process Art Process Writing 4 writing. The Representative work column gives titles or descriptions of one or more of the originator’s works and includes indicators of two sources: the Prinzhorn Collection (PC) and the Collection de l’Art Brut (AB). Wurmbrandt (head-roasting cure) Letter/postcard to Jodie Foster Photo of dyslexic child’s writing Universe Inversion (PC) Paintings of alcoholism Maisons (AB) Note. van Gogh remains the quintessential exemplar of the mad artist (cf. often during hospitalization. The mirror image of the mad artist is Prinzhorn’s (1922/1995) “schizophrenic master” or. Despair. HENDERSON. Adolf Wo ¨ lfli.176 SCHOENEMAN. a Originator’s work appeared in multiple editions of only one textbook. Table 2 also contains the artworks of mentally disordered amateurs other than those represented in the Prinzhorn and Art Brut collections. The Dead Mother & the Child Flowers-in-vase series (paranoia) Worm Holes etc. these two institutions account for 13% of the pictures in our sample. the artist is seen as using the swirling moon and stars of the night sky to represent the inner turbulence of his bipolar disorder. the mentally disturbed individual who develops artistic excellence. more generally. and Aloise Wey. Aloise Weya f 12 11 11 11 9 9 9 8 8 8 7 6 6 6 6 6 6 5 5 5 5 5 5 5 5 5 No. 1). the number of works is the number of different titles by the originator that appear. DID ϭ dissociative identity disorder. of works 7 1 3 5 4 3 3 3 3 4 4 1 6 4 2 3 3 1 1 2 1 2 2 2 2 3 Picture type Art Process Art Process Art 8 process. The prominence of van Gogh’s work in our sample supports MacGregor’s (1989) suggestion that. far more than any other source acknowledged in textbooks’ picture credits. series of paintings depicting the progression of paranoid schizophrenia (Anonymous 1) and Alzheimer’s disease (Anonymous 4). Frequencies are the frequency with which the originator’s work appeared in 38 textbooks. Joey). These include portraits of the alters of people diagnosed with dissociative identity disorders (Chris Sizemore. outside the discipline of art history. see Figure 5) Drawings of sadistic fantasies Windmill series (Alzheimer’s disease) Elizabeth & the Beasts Bender–Gestalt Test copies Moonstruck women (18th century) Untitled (PC) Dr. Joseph Sell. AND WEATHERS Table 2 Originators of Interior Landscapes of Mental Disorder Originator Vincent van Gogh Girolamo di Benvenuto Chris Sizemore/“Eve” Roz Chasta Billy Milligan Edvard Munch Anonymous 1a August Klett/Klotz Nadia Joeya Louis Waina Anonymous 2 John Vassos Adolf Wo ¨ lfli Anonymous 3a Anonymous 4a Elizabeth Moudinea Anonymous 5 Anonymous 6 Franz Karl Buhler Matthias Greuter John Hinckley Will and Deni McIntyre Joseph Sell/Schneller W. Schoeneman & Marley. Adolf-Giant-Creation (AB. Billy Milligan).

9. The Expressionists. 29 ϫ 361⁄4 in. through his madness and creative genius. In the sample as a whole. Nathan. and paintings by a schizophrenic (Moudine) and an alcoholic (W. O’Leary.. van Gogh became both “a contender for the position of the most widely known European artist” (McQuillan. & Clark. Vincent van Gogh. 1994. The written materials in Table 2 consist of two of John Hinckley Jr. Van Gogh (1853–1890) used exaggerated depictions of nature to express human emotions. (472. 1989). in fact.). 1996. p. see also Chilvers et al. A textbook in our sample noted that “Vincent Van Gogh probably suffered from bipolar disorder” and presented this picture because it “expresses the expansive. The Starry Night (1889).INTERIOR LANDSCAPES OF MENTAL DISORDER 177 Figure 1. 199). Over the course of the 20th century. creative quality of [the artist’s] mania” (Wilson. the majority of the 80 assessment pictures in our sample were figure copy and drawing tasks from tests of . Bliss Bequest.1941) Copyright by The Museum of Modern Art/Licensed by SCALA/Art Resource. Table 2 contains examples of two other kinds of product pictures: writing samples and assessment results. 44 of 54 (81%) written products and 9 of 10 art–writing mixtures appeared anonymously. p. 1905–1930). promoted the movement’s ideal of challenging conventional perceptions of reality. in this regard he was a forerunner of German Expressionism (ca. adopted van Gogh as a kind of patron saint who. In addition to works of art produced by the mentally ill. 7) and “like a site where discourses on madness and creativity converge” (p. Acquired through the Lillie P. drawings of the sadistic fantasies of an autoerotic asphyxia fatality (Anonymous 3).’s messages to Jodie Foster prior to his presidential assassination attempt (reproduced five times) and a photograph of a dyslexic child’s printing containing reversed and transposed letters (f ϭ 4). 1989. New York. The most prominent of patients’ assessment products in our sample was a set of Bender–Gestalt Test figure copies taken from Lacks (1984) that appeared five times (Anonymous 5 in Table 2). MacGregor. In fact. Oil on canvas.

1994. . and Vassos) and of the more anonymously presented images supplied by picture services (Anonymous 2 and 6). Note that the process pictures in Table 2 are a mixture of works by professionals whose names are given in captions (Benvenuto. In fact. 12%). Qualitative Aspects of Interior Landscapes of Mental Disorder We now turn our attention to aspects of interior landscapes of mental disorder that lie outside the reach of our formal content analysis. p. satisfy the empathic function of showing what it is like to have a particular disorder (Captions 1 and 2 in Table 3). there were 17 instances in which captions mentioned the diagnostic function. Thus. the term shifted meanings from the 17th through 19th centuries: “The word ‘grotesque. cartoons. we offer the following generalizations. by definition. . The remaining 8% consisted of six Draw-APerson (Aiken. 79%) and developmental disorders (f ϭ 10. we drew a random sample of 34 pictures (5% of the total sample). came to imply whatever is incongruous with the accepted norm whether in life or in art” (Chilvers. although they can also express the diagnostic function if the process as depicted is claimed to be typical of a particular disorder (Caption 3). Wolfgang Kayser (1963). capitalization in the original). exorcism scenes. was more specific: “The grotesque is a structure. our impression that captions almost always express one or more of these three functions. the grotesque and the naturalistic. The grotesque in interior landscapes of mental disorder. The term grotesque serves as both a colloquial and a technical description. By our count. Its nature could be summed up in a phrase that has repeatedly suggested itself to us: THE GROTESQUE IS THE ESTRANGED WORLD” (p. 11 presented two functions. Reproductions of patients’ writing and assessment results seem to serve the diagnostic function almost exclusively (Captions 4 and 5). The remaining 120 came from the collections of picture services. Artworks are versatile: They see service as expressions of the artist’s unique psychology and as the typical productions of a type of patient (Captions 6 and 7) as well as serving as windows into the experience of those suffering from a disorder (Caption 8). All assessment pictures in the sample were anonymous. empathic. It was. In art history and criticism.’ originating as a technical term designating a late Roman type of decoration and a Renaissance decorative style based upon it. In an attempt to pursue this impression (albeit somewhat informally) and to generate examples for use in this report. AND WEATHERS cognitive and intellectual functioning: These included 39 Bender–Gestalt Test copies (49%).” on one end Picture Captions and the Functions of Interior Landscapes of Mental Disorder It seems reasonable to expect that the descriptions and explanations given by picture captions contain expressions of the diagnostic. Too much space would be needed to reproduce all of these captions. 184. All 30 of the captions attached to these pictures fulfilled one of the three functions. Assessment pictures were produced primarily by patients with organic brain syndromes or mental retardation (f ϭ 63. and 11 in which they mentioned the madness– creativity function. Osborne. & Farr. handwriting samples. they can: Depictions of psychological interiority seem to cluster into two varieties. 1995) results and one reproduction of a self-monitoring journal. 13 in which they mentioned the empathic function. HENDERSON. 27 other figure copies (34%). 87 pictures by 35 notable artists and cartoonists constituted 42% of all process pictures. Chast. Process simulations. visual simulations of psychological processes such as anxiety and delusions. 180. Table 2 also contains frequently occurring pictures that are used as simulations of disordered psychological processes. 222). and madness– creativity functions of interior landscapes of mental disorder. the viewer of a grotesque is likely to react using descriptions ranging from “strange” and “odd. . Munch. Bender–Gestalt Test figure copies and the like—raises a question about whether any pictorial commonalities could possibly be discovered. and 7 figure drawing tasks (9%). . On the basis of an examination of the random sample of 30 captions and of the complete sample. In our sample as a whole.178 SCHOENEMAN. in fact. in his book The Grotesque in Art and Literature. artworks also seem to be the primary locus of correlations drawn between mental disorder and artistic productivity (Captions 9 and 10). Two questions interested us: What do textbook authors write in describing these pictures? Is it possible to characterize the visual aspects of pictures that represent the inner experience of mental disorder? Visual Elements of Interior Landscapes of Mental Disorder The diversity of images collected in our sample— paintings by mentally ill amateurs and professionals. but Table 3 displays 10 that we can use as examples.

“Two figure drawings illustrating the defensive hysteroid (left panel) and the defended depressive (right panel) sides of a character neurotic personality” (Willerman & Cohen. “How it feels to have an epileptic seizure. Lausanne. who lived during the late 1800s to early 1900s. they usually cannot summon up or implement these ‘insights’” (Nevid. 277). unstimulating environments” (Sue. 7. this trend can be found in the works of Vincent van Gogh and Edvard Munch near the turn of the 20th century. Sue. “In the various forms of dissociative disorders. considered to be abnormal” (Carson & Butcher. 9. In the history of art. Henry Fu ¨ ssli. p. 1987.’ but when the drug wears off. inside front cover). “This painting is typical of artwork produced by schizophrenics. & Greene. “The cartoonist Roz Chast has captured the thinking that is typical of a depressed person” (Sarason & Sarason. “Paintings by schizophrenic patients that suggest the disturbance of affect and sense of self that are often present with the disorder . 1994). The expressionist trend in interior landscapes of mental disorder is characterized by distortions and exaggerations of line. (Bottom) The partly hidden ghostlike figure painted by this patient suggests depersonalization and loss of identity” (Bootzin & Acocella. 343). although the individual is still fully conscious.. 3. 231). passions. 1987. p. 1990. p. 431).” and “weird. Those who develop them later than average often are at a disadvantage in kindergarten and in later school years” (Sarason & Sarason. called auras. Picture type and function Process: empathic function Process: empathic function Process: empathic and diagnostic functions Writing: diagnostic function Assessment: diagnostic function Art: diagnostic function Art: empathic and diagnostic functions Art: empathic function Art: madness–creativity function Art: madness–creativity function of a continuum. Rathus. sometimes autobiographically (Chilvers et al. & Jamison. p.INTERIOR LANDSCAPES OF MENTAL DISORDER 179 Table 3 Examples of Captions and the Functions They Serve Caption 1. p. and in German Expressionist films of the 1920s and American horror movies and films noir of 1930 –1960. 360). Baker. an aura can help steel an epileptic for the ordeal of a seizure” (Goldstein. This drawing was made by a victim of grand mal epilepsy. . Many epileptics have visual premonitions of an oncoming seizure. 1988. for one reason or another. 1986. 1986. and John Vassos (see Figures 1 and 2) and photography that uses techniques such as multiple exposure. “The artists [in the Prinzhorn Collection] were mentally ill patients. highcontrast shadowing. 8. . Terrifying as it often is. surrealism. Some users have claimed to have achieved great insights while ‘tripping.” “bizarre. p. p. 5. 2. 318). and blurring to . color. Munch. 1986. How do the pictures in our sample achieve this estrangement? A scrutiny of the pictures themselves and of the names and works of prominent artists in the sample suggests three strategies used in the visual depiction of the grotesque: expressionism. James Ensor. 1988. 257). and perspective. not as a part of a therapy program. 10. shadow. Switzerland)” (Meyer & Salmon. by people living in socially isolated. to “fantastic. 1994. and naivete ´ . with no formal artistic training. form. never realizing the source of their anxiety is within themselves” (Duke & Nowicki. 1992. “[The Collection de l’ Art Brut] provides an extraordinary glimpse into the inner lives and private visions of cultural outsiders and confirms Dubuffet’s sense of the profound talents that often lie within those who are. (Collection de l’ Art Brut. LSD is an hallucinogenic drug that gives rise to a vivid parade of colors and visual distortions. anxieties. 4 “Learning to write requires a certain degree of coordination and cognitive skill. Examples of the expressionist trend in our sample include pictures by professional artists such as van Gogh. people appear to be trying to run away or distance themselves from the source of their anxiety. “An LSD trip. A remarkable aspect of this art is that it was produced spontaneously. In this tradition. Children develop these skills at different rates. These experiences resemble dreams. p. . 427). & Sue. in the Expressionist movement in German art circa 1905–1930. 6.” on the other. and psychopathologies. artists used distortions of the physical world and human form to express emotions. They were most often diagnosed as schizophrenic and did not express themselves artistically until after the onset of their illness. zoom effects. p. 164).

The Surrealist movement in the 1920s and 1930s was heavily influenced by the psychoanalytic conception of an irrational unconscious. Yves Tanguy. Our sample includes pictures by Surrealists such as Salvador Dali. Paintings and drawings by schizophrenic . Illustration courtesy of the University of Syracuse Library. Acrophobia (1931). and Wilfredo Lam alongside more recent depictions. Department of Special Collections. which resulted in highly detailed representations that made no rational sense. HENDERSON. Friede (see also Vassos.180 SCHOENEMAN. 482). published in 1931 by the New York firm of Covici. John Vassos. Rene Magritte. The surrealist approach is “characterized by a fascination with the bizarre. artists and writers of this school tried to fuse the realm of dreams and halluci- nations with external reality. the incongruous. such as a photograph that represents schizophrenic perceptual disorder as a white cat with numerous human eyes and mouths superimposed onto its body (see Figure 4). Vassos (1898 –1985) used darkness and the distortion of perspective and form to convey the fear of heights. This illustration is one of 23 collected in a limited edition of Phobia. 1976). dissociation. AND WEATHERS Figure 2. and the irrational” (Chilvers et al. and other pathological processes (see Figure 3).. p. suggest experiences such as hallucination. 1994.

There are. distortions present in the printing of dyslexic children and the figure copies of patients with brain lesions. of course. rather than in a stylized or conceptual manner” (Chilvers et al. 1994. 1989. Dan McCoy. Down the Road. 3) that are “lacking in conventional expertise in representational skills” (Chilvers et al. The earliest works of this type include all 40 of the possession and exorcism scenes in our sample (6%. Naturalism in interior landscapes of mental disorder.INTERIOR LANDSCAPES OF MENTAL DISORDER 181 Figure 3. members of “primitive” societies. 351). . however. see Table 1). Not every internal landscape of mental disorder fits into the category of the grotesque. The expressionist zoom effect in this photograph is used to depict the interior experience of psychogenic fugue in three textbooks in our sample.. the founder of the Art Brut collection.. A second type of naturalistic picture involves a more or less realistic depiction of a person’s exterior appearance along with the inclusion of a “thought bubble” containing words or pictures. unconstrained creativity (cf. figure copies. and perceptual expectations of realism. In naive painting. In our sample. The first type of naturalistic depiction of interiority involves all of the 134 assessment results and writing samples in our collection (20% of the entire sample): These are reproductions of handwritten notes. in their efforts to break away from social and artistic conventions and approach a purer. surrealist. and naive characteristics is incongruity: These pictures contain features that depart from artistic. social. The term naive has been used to characterize the work of well-known artists such as Henri Rousseau and Grandma Moses and also artifacts produced by children. perspective nonscientific. the common thread that we have identified in pictures that show expressionist. Copyright by Dan McCoy/Rainbow. and so on that seem to be presented to the reader as empirical data. Caption 9 in Table 3). 439). 1994. We use the term naturalism to describe “an approach to art in which the artist endeavors to present objects as they are empirically observed. but the emphasis in these pictures seems to be on normative errors rather than on strangeness or incongruity. p. “colors are characteristically bright and non-naturalistic. 1994. and vision childlike or literal-minded” (Chilvers et al. p. p. Three subsets of the pictures in our sample are free of distortions and incongruities. and artists such as Jean Dubuffet. In fact. naive art has been of considerable interest to Expressionists. There are some that strive for an apparent naturalism. and social outsiders (including the mentally ill). Surrealists. (and other mentally disordered) masters also partake of the incongruity of the surreal in our sample (see Figure 5). Naive art includes “curiously crude objects and images” (MacGregor. naive characteristics can be seen primarily in the works of mentally disordered masters and amateurs (Figures 5 and 6). for example. 439). p. Again..

1994). p. 2003). The photograph was originally produced for an exhibit at the Children’s Museum of Manhattan that had nothing to do with mental illness (M. HENDERSON. Photograph copyright by Michael Weisbrot. The next manifestation of pictures containing thought bubbles occurred with the work of 19th century caricaturists such as George Cruikshank and Honore ´ Daumier. or naive styles. Sidney Harris. appears in a textbook with the following caption: “Everyday objects can make some unexpectedly frightening changes as schizophrenics experience hallucinations” (Duke & Nowicki. such as Roz Chast. 1993). This picture. & Gresham. Michael Weisbrot.182 SCHOENEMAN. AND WEATHERS Figure 4.. personal communication. September 2. and Gary Larson. 163). Discussion There are a number of findings in this study that warrant further discussion. Segerstrom. An approximate and conservative estimate therefore puts the proportion of grotesque pictures in our total sample at 60%. The final trend in naturalism in our sample involves a very small number of pictures that are rendered realistically but with an apparent expressionist intention in either the artist’s execution or textbook authors’ intended use. surrealist. 32% of the pictures in our sample belong to one of the three categories of naturalistic pictures. Mindy’s Cat. Our experience in scrutinizing these latter pictures suggests that an overwhelming majority conform to the grotesque style of interior depictions. There are only six process pictures in our sample (1%) that are rendered in a naturalistic style. but space considerations do not permit us to be exhaustive. It is possible to estimate the relative proportions of grotesque and naturalistic depictions in our sample of interior landscapes of mental disorder. 32 pictures (5%) are 19th and 20th century cartoons involving thought bubbles. The remaining 68% are artworks and art–writing mixtures. Griffin. with its surreal superimposition of eyes and mouths on a white cat. 1986. Weisbrot. In our sample. process pictures by artists known to use expressionist. these artists were the forerunners of the 20th century cartoonists in our sample. This public awareness of schizophrenia has a . and anonymously produced process pictures from picture services. As noted above. Examples include paintings of George Tooker and Edward Hopper. these pictures date from the 16th century and usually present a demon exiting through the mouth or ear of the patient (see Figure 7). which are said to express the loneliness and alienation of modern life using starkly realistic subjects and styles (Chilvers et al. In the balance of this article we focus on three questions raised by our findings: Why is schizophrenia so predominant in our sample? What intended and unintended messages are conveyed by interior landscapes of mental disorder in textbooks? Do these pictures promote viewers’ acceptance of the mentally ill? Interior Landscapes of Schizophrenia Schizophrenia has been identified as the prototypical mental disorder in a survey of modern Americans’ implicit categories of psychiatric diagnosis (Schoeneman.

Schoeneman & Marley. depressive disorders and alcoholism surpass schizophrenia. render this statement problematic.INTERIOR LANDSCAPES OF MENTAL DISORDER 183 Figure 5. in fact. Schizophrenia is clearly an extremely debilitating disorder. Entre les Deux Villes Geantes Niess et Mia (1924). psychiatric interest in the art of the mentally ill has often taken the form of analysis of the works of “schizophrenic masters” (MacGregor. In addition. 1992. impact on family members and other people. Brooks. in terms of loss of rationality and personal agency. and disorder-related deaths. Colored crayons on paper. & Routbort. whereas other chapters deal with clusters of related disorders. A few moments of consider- ation. Lausanne. 51 ϫ 68 cm. 1989). however. Adolf Wo ¨ lfli. Wo ¨ lfli (1864 –1930) was the subject of a major exhibition at the American Folk Art Museum in 2003 (Spoerri. cost to the economy. 2003). & Wo ¨ lfli. This work by a schizophrenic master shows both surrealist incongruities and the unconventional techniques of naive art. the most severe mental disorder. We have suggested elsewhere (Schoeneman et al. 1994) that schizophrenia is both a violation of Western conceptions of the individual. photo by Henri Germond. Lausanne. It is not surprising that schizophrenia is represented in textbooks by more pictures of sufferers than any other disorder (Schoeneman. Saint Adolf Portant des Lunettes. If we consider loss of function and capacity for independent living. 1995). Gibson. For these reasons. Many abnormal psychology textbooks devote two chapters to this disorder. from the Collection de l’Art Brut.. schizophrenia has rivals in Alzheimer’s disease and other organic brain syndromes and in developmental disorders such as autism and mental retardation. Baumann. In terms of number of people affected. One could also assert that schizophrenia receives so much attention because it is. and a major example in the public mind of the centuries-old stereotypical figure of active mad- . but part of its perceived severity may derive from a larger social ideology. it is not surprising that schizophrenia was the preeminent diagnosis in our sample of interior landscapes of mental disorder. parallel in professional interest. Jacobs.

a work that exemplifies techniques of naive art. to represent the schizophrenic interior suggests that it is conceived to be a disturbing yet fascinating place. No other disorder in our sample receives this amount or kind of attention. This Romantic outcropping may be the same tendency that made it possible in the 1960s for R. AND WEATHERS Figure 6. the viewer sees both the external appearance of a famous case of multiple personality disorder and the interior experience of dissociative identity disorder. passionate core that erupts into artistic expression may be seen as evidence of a strain of Romanticism that inhabits these textbooks. The Washington Post. Laing to propose an analogy between schizophrenia and LSD trips and that fuels continued interest in Freudian and Jungian psychoanalysis (Gilman. Copyright © 1975. In this photograph of Chris Sizemore. The prominence of interior landscapes of schizophrenia in our sample may reflect the disorder’s prototypical status in this culture. and appearance of the patient. The current study adds interesting details concerning the cultural imagination of schizophrenia. D. 1985. The latter is represented by the three-faced figure in Sizemore’s painting. There seems to be a strong impulse on the part of textbook authors and their audiences. the maniac. Uses and Effects of Interior Landscapes of Mental Disorder In our examination of pictures and captions from current abnormal psychology textbooks. 1989). we found . Reprinted with permission. The heavy use of schizophrenic art. We speculate from this that schizophrenia is a cultural construct that is endowed with considerable interiority: There is a fascination with the inner landscape of schizophrenia. dominated as they are by modernist science. behavior. Photo by Gerald Martineau. MacGregor. as well as the culture in general. The connections suggested between schizophrenia and a turbulent. HENDERSON. who was given the pseudonym of Eve in The Three Faces of Eve. a place that cannot be directly observed but can only be inferred from the unusual speech. to want to look into the mind of the schizophrenic—far more so than for any other disorder. a body of work noted for its strangeness.184 SCHOENEMAN. teachers and students. ness.

In general. Denver Art Museum. St. Gilman. provided disclaimers that counteract the idea that art can have diagnostic utility. 1982. in fact. and no authors made the claim that people with different disorders produce differentially characteristic drawings. 1972. with the interior process represented by the demon exiting from the possessed woman’s ear. In some cases. The diagnostic function. transferred to Masonite. captions assert that a painting is typical of a particular disorder or that an artistic production is a manifestation of specific symptoms of a disorder (see Captions 6 and 7 in Table 3). apparently more innocuous cases. given that the picture is often embedded in a chapter that discusses the signs and symptoms of a particular kind of disorder and (especially in the case of schizophrenia) may appear alongside other artworks by individuals with the same diagnosis. an artwork is identified by title and artist and perhaps a diagnostic label and a brief case history. and empathic functions are operative. 1989). We call the inclusion of these pictures appropriate because they have demonstrated reliability and validity as diagnostic aids (Aiken. These pictures do not appear to suggest the diagnosticity of artworks but may. MacGregor. may not be suffi- . do so: The reader may generalize from the individual case to the diagnostic group. At the other extreme. Schoeneman et al. Authors’ verbal disclaimers. Catherine Exorcising a Possessed Woman (ca. Some authors. Appropriate uses of pictures for the diagnostic function in our samples include the display of Bender–Gestalt Test and other figure copy assessment results used to illustrate brain dysfunction and perhaps some of the writing samples that show suicide notes or dyslexic errors. if given. DrawA-Person and other directed drawing assessment results. and spontaneously produced artworks over a claim that analysis of these materials can be used to make reliable diagnoses (Aiken. but we haven’t yet discussed the issue of unintended messages given by the use of these pictures: Authors may use interior landscapes of mental disorder to serve a particular purpose. madness– creativity. Let us briefly consider the three functions with an eye toward this question of unintended messages. Nevertheless. these inappropriate expressions of the diagnostic function did not occur often in our sample: There were no instances of handwriting analysis and only six reproductions of directed drawing assessments. 1995). 1500 –1510). 1995. Oil on panel. 1994). in fact. or sculptures. paintings. A painting in the naturalist style. In other. we suspect that readers may be receiving unintended messages about the diagnosticity of artworks. copyright by Bettman/CORBIS.INTERIOR LANDSCAPES OF MENTAL DISORDER 185 Figure 7. it is inappropriate to display handwriting samples. Girolamo di Benvenuto. but the pictures’ semiotics may convey information that is not intended (Berger. that the diagnostic..

It is also possible that the inclusion of so many reproductions of the artworks of the mentally ill in these textbooks suggests to viewers that disordered art is distinctively different from normal art. On the other. and an actress. The empathic function. AND WEATHERS cient to counteract impressions of the diagnosticity of patients’ artworks that are given by the vivid reproductions that appear within the text (Nisbett & Ross. we believe that the vividness and frequency of reproductions of artworks by disordered individuals probably override verbal lessons and may reinforce the stereotype of the mad artist or genius—the idea that “Great wits are sure to madness near allied/And thin partitions do their bounds divide” (John Dryden. HENDERSON. cited in Kessel. on the one hand. 19 were portraits. creativity. is generally not associated with the pictures in our sample. The 3 remaining pictures that were associated with the visual arts were also a part of our sample: They were paintings by van Gogh. It is interesting to note that the Kraepelinian hypothesis. 1980). it seems strange to question the potential impact of these metaphors beyond their descriptive uses: Are they not the visual equivalents of verbal metaphors. Of the 22 pictures that accompanied the presentation of the hypothesis. however. The portraits included eight authors. These authors made three assertions that are relevant here. Textbook authors definitely do intend that process simulations and artworks should convey to viewers some idea of the experience of mental disorder (see Captions 1–3 and 7–9 in Table 3). five politicians. only 3 were interior landscapes of mental disorder. which connects creativity to bipolar manic and hypomanic episodes. our thinking and speech are so full of metaphors that we are generally unaware of them. If we were to present an array of artworks produced by Expressionist. we can then question the adequacy of these metaphors: Is out-of-focus photography a good approximation of anxiety? Does a darkened image really inform the reader about the experience of a major depressive episode? Can a densely detailed drawing truly represent a schizophrenic disorder of attention? We can also ask whether the use of these kinds of visual metaphors has any consequences for the viewer’s perception and action beyond sympathetic understanding. On the one hand. or genius. Sixteen (42%) textbooks mentioned the bipolar hypothesis. drawings by autistic savants. on the other. de- . darkness and depression. 1985. 197). If readers of abnormal psychology textbooks do infer that there are distinctive differences in abnormal artworks. five composers. The question then arises about how well these pictures serve the empathic function. but verbal descriptions also draw attention to the creative talents of disordered individuals and groups (see Captions 9 and 10 in Table 3). Surrealist. In the first place. p. Eighteen textbooks (47%) in our sample assembled three or more artworks within chapters on schizophrenia. for example. Readers may also come to believe the obverse of the mad artist stereotype—that is. if we construe interior landscapes of mental disorder as assemblages of visual metaphors for disordered mental processes.186 SCHOENEMAN. Picture captions indicate that authors sometimes use these artworks to fulfill the diagnostic and empathic functions (see Captions 6 –9 in Table 3).” or “Individuals who suffer from Y sometimes show great artistic talents. and Naive artists alongside the works of schizophrenic masters and disordered amateurs— or a collection of works by mad artists such as van Gogh and Munch alongside the paintings of their less disturbed artistic peers and descendants—we suspect that laypersons and mental health professionals would not be able to reliably distinguish the works that were the products of troubled psyches. More specifically. that latent creativity is released when a person becomes afflicted by a disorder such as schizophrenia (Gilman. Rather. and pieces from the Prinzhorn and Art Brut collections. 1989. In visual terms. and either specific mental disorders or mental illness in general. might they not also wonder if all nonrealistic styles of art are representative of eccentric and even disordered minds? The madness– creativity function.” Nevertheless. These questions may seem odd at first glance. be giving the impression that such a distinction is possible. Textbooks may. it seems entirely obvious to equate. and four (11%) mounted this kind of exhibition throughout the entire volume as chapter openers. To continue with our previous example. the connection presented in textbooks of abnormal psychology between mental disorder and creativity is striking. Sontag. 1990). These latter captions generally do not explicitly claim that there is a substantial correlation or causal connection between artistic talent. captions usually take one of two forms: “X was an individual with Disorder Y who showed great artistic talents. portraits of multiple personality disorder alters by Chris Sizemore and Billy Milligan. figures of representation that are like figures of speech? The work of Lakoff and Johnson (1980) on metaphorical thinking in everyday life suggests that this question has answers that are far from trivial. These texts are full of reproductions of paintings by van Gogh and Munch.

Three points seem worth making in this regard. Schoeneman et al. 184). and otherness (Gilman. Darkness Visible: A Memoir of Madness. We raise these points in the hope that they will stimulate a continued scrutiny and questioning of the use of interior landscapes of mental disorder for empathic purposes. and they are clearly a feature of several important Western art movements of the late 19th and 20th centuries. relevant research has examined the depiction of AIDS and it sufferers. First. however. Finally.INTERIOR LANDSCAPES OF MENTAL DISORDER 187 pression is not literally darkness or dark colored. 325). Schoeneman. In addition. Second. In contrast. and darkness has other connotations in our culture besides disordered mood (e. venues that are sympathetic to victims of this disorder. & Obradovic. depictions of the experience of madness are blueprints for social behavior. In the realm of images. & Stallings. heaviness. Two examples demonstrate this. these stereotypic depictions do not exist in isolation. Conclusion We have given extensive attention in this report to a particular kind of stereotype as it exists in a particular kind of cultural institution.. described one aspect of visual representation that characterizes a large portion of our sample: the use of incongruity and distortion to depict the experience of mental disorder. evil). thus setting up very real conflicts between legal and medical authorities and the social groups in which the authorities are embedded. Styron first described depression using metaphors that seem calculated to increase the distance between normality and depression: Depression is down. and knowledge of . These analyses have found that the more liberal news media as well as college-level textbooks. culpability. We think that the inclusion of grotesque depictions of inner experiences in textbooks of abnormal psychology provides a potentially troubling answer to our question about whether interior landscapes of mental disorder promote readers’ acceptance of the mentally ill. victimization. and through. and depictions of external appearance) and cultural constructions of the Other for the purposes of explaining misfortune and defining “the good” by contrast (Gilman. narrative themes. 2002). They are part of a web of meanings that include other aspects of stereotypes of mental disorder (attitudes.g. 1988. p. Thomas Szasz (1960) has pointed out that the metaphor “Abnormal behavior is (like) illness” absolves people from responsibility for their actions. Schoeneman. Sontag argued further that the metaphors “Cancer is (like) an invading army” and “Chemotherapy is (like) war” can contribute to feelings of helplessness and delays in seeking treatment on the part of the patient as well as avoidance of the patient by others. out. interior landscapes of mental disorder are part of a cultural system of social representations that may promote distance from the mentally ill in the minds of individuals. night. Schoeneman. and counterattack used to describe the onset and treatment of cancer and AIDS cause unnecessary distress to people who have these disorders. he portrayed his recovery in largely opposing terms that seem to erase the divide between the reader and the author: Recovery and mental health are up. We have. 1994). If “the grotesque is the estranged world” (Kayser. we can consider a recent analysis of William Styron’s (1990) rhetorical strategies in his memoir of major depression. but we use the analogy so much that the pairing seems natural. then these depictions of incongruities may emphasize the difference of the mentally ill and maintain the distance between the viewer and the Other even while they are attempting to promote empathy. for verbal and visual metaphors to promote empathy and sympathy while simultaneously maintaining the distance between self—the viewer—and the Other. visual depictions of the experience of mental illness are not limited to a specific kind of psychology textbook: They are easily spotted in such nonpedagogical venues as advertising and entertainment. a sequential process of return to a life of goodness and light (Schoeneman. “Depression is (like) darkness” coexists with other metaphors that link depression to downward directionality. For instance. neverthe- less continue to anchor AIDS pictorially to concepts of death. If this is so. p. Lakoff and Johnson (1980) and others have asserted that metaphors are not just figures of speech (or representation): They have consequences for individual and social behaviors. in. alienness. Susan Sontag (1990) has suggested that warfare metaphors of invasion. 2004. 1982. and foul weather (to name a few). A thorough examination of visual metaphors of mental disorder and their interconnections and action consequences is beyond the scope of this article. and away and a sequential process of suffering and adversity that is a form of malevolence and annihilation. One could ask whether this extreme particularity might limit the topic’s interest to psychiatrists and psychologists. of course. 1963. It is possible. Finally. attack. A second point to consider is that metaphors in everyday cognition do not exist in isolation but are a part of a web of related and consistent metaphors..

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