I have been following the work of Gordon Claridge, an Oxford University psychologist, for years. He has presented much research demonstrating that “normality” and psychosis are continuous with each other. He believes that neither a strict social interpretation nor a biological viewpoint of psychosis as a neurological disease can entirely explain the research evidence. A good source of his work and ideas can be found in Origins of Mental Illness published in 1995 for Malor Books, Cambridge MA. I would like to draw on recent work he has done in collaboration with two literary critics. The material is taken from Sounds from the Bell Jar by Gordon Claridge, Ruth Pryor and Gwen Watkins published in 1998 by Malor Books. In this very interesting volume, the authors explore the lives and works of ten authors, including Virginia Woolf, Sylvia Plath, John Ruskin, Antonia White, etc., who all embodied forms of mental illness as well as great originality of thought. The book draws on personal diaries, historical archives, clinical records, literary productions, etc., to explore the links between madness and creativity.

I will cover the aspects which lie outside of diagnostic psychiatry, but are relevant to their creative psychosis. The most common feature noted in all authors could be described by the word-”skinlessness,” a word used by Virginia Woolf’s father, Leslie Stephen to describe himself. E. J. Anthony, psychiatrist and psychoanalyst, also saw this as an overriding characteristic of persons prone to psychotic breakdowns. Plath wrote: “It’s as if neither of us, or especially myself, had any skin.” Plath described her experience of herself:

“I am afraid. I am not solid, but hollow. I feel behind my eyes a numb, paralyzed cavern, a pit of hell, a mimicking nothingness.”

This skinlessness can appear in nightmares, in sensitivity to bodily complaints, hyperawareness to sensory stimuli. Many of my patients complain of persecutors entering their bodies through various orifices-’outside’ can easily move ‘inside’ and ‘inside’ can be immediately translated to ‘outside’ (e.g., aggressive thoughts are equated with actions).

Claridge speaks of the conjunction of a hypersensitivity with withdrawal/retreat (similar to Gaetano Benedetti’s views of psychosis as a difficulty in integrating separate/autonomous and symbiotic/related selves). August Strinberg, author and playwright, once said of himself: “I am hard as ice, and yet so full of feeling that I am almost sentimental.” Kretschmer concluded that an essential quality of schizoidness is a simultaneity of being cold and oversensitive. Lack of feeling may be a defense against feeling too much, being too permeable, “skinless.” Anger and hate which is chronic can be a response to this state of permeability and “skinlessness.” One of my patients is chronically hateful of the persecutors who colonize and steal from him, e.g., his strength, manliness, good looks, etc.

Claridge points out that this incomplete sense of self is most acutely felt when the person is alone. For it is then that the person must confront her or himself, unsupported by the sense of certainty, e.g., that she or he exists, which being with others might give. The previously mentioned patient experiences tormenting paranoid and somatic delusions, e.g., being raped, having cancers put into his body when he is alone, and during sessions all of these cease to exist. His frequent daily phone calls over 6-7 years in which he can leave a message and receive a phone call back, help him feel protected from all of these persecutors, which I believe are reifications of his flickering sense of personal existence, especially when feeling lonely and isolated. Defenses against this state, e.g., his previous crack abuse, only serve to further alienate him from himself and others, thereby compounding his difficulty in integration of self. Claridge noted:

“This simultaneous need to escape the self and yet escape those who threaten it has been described as the inner shambles of the psychotic personality” (p. 225).

One author (Benson) wrote: “I like solitude, and it does not suit me.”

Claridge commented on the role of mirrors in the lives of these ten authors. A precarious sense of self can sometimes be bolstered by looking in mirrors (for proof that one exists) or made worse, depending on what one sees in there. I had one patient who avoided looking at mirrors because of his monstrous self-image. Another of my patients when he looked in the mirror saw his mother’s face with gnashing teeth “branded” into his own face. He had a fear of being swallowed whole by others if he got close to them, yet he could not tolerate separateness. Virginia Woolf avoided mirrors after seeing a hideous animal face (non-human self image?) in the mirror as a child. Plath wrote frequently of mirrors. One patient I know of constantly looked in the mirror to make sure no parts of her skin were ripped away by the persecutors. The mirror may serve as a kind of a interlocutor in those who are very isolated. Gaetano Benedetti and Heinz Kohut used the metaphor of mirrors in their psychoanalytic views of self-disorders and psychotherapeutic repair.

The role of transgenerational transmission of trauma in these authors’ lives was commented on by Claridge. Both involved actual early loss of parents replaced by disturbing presences. Antonia White said: “The trouble with my mother was her father.” Unconscious thoughts and memories relating to aggression and hatred may be especially important in exacerbating a thought disorder, as are memories of loss and other kinds of trauma, e.g., sexual abuse.

The absent or precarious sense of self may result in excessive preoccupation with self. The world, as in self-referential beliefs, revolves around oneself. In therapy, this can be manifested as a form of “this town ain’t big enough for both of us.” or in a kill-or-be-killed emotional atmosphere in the room.

Claridge rejects any simplistic genetic etiology of psychosis, as he rejects solely a social interpretation. He views psychosis as continuous with mental health and as a subtle psychobiological disorder rooted in the human condition. Currently, most genetically oriented researchers of the schizophrenias conclude that they are multifactorial, polygenic disorders which are in a dose response non-linear relationship with multiple high risk environmental/social factors. We now know that environment (phenotype) can override genes (genotype), particularly in affect regulation and stress reactivity, factors often cited in stress-diathesis vulnerability models of the schizophrenias. The role of social and personal experience (across the generations) in gene expression (epigenetics) needs to be taken more seriously if we are ever able to construct valid models of the schizophrenias and give to patients and their families a better compass in which to navigate out of the labyrinth of psychosis.

Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net