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

2, 171189

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 fulll 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, conrming 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: schoen@lclark.edu

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 briey 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 gures 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 philosophers poseseated, eyes downcast, head in handswith face and gure 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 fools 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-

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come standard: the artistic products of mentally ill individuals, and artists renditions of disordered mental processes. The rst stage in the emergence of interest in interior landscapes of mental disorder began in the middle 1800s. A conuence of 19th century Romanticism and moral psychiatry spurred interest in the art of the insane as a window into the phenomenology of madness (Gilman, 1982, 1985; MacGregor, 1989). Romanticists were fascinated with the inner emotional life of the passionate, core self; they considered madness to be a heightened state of awareness that was, in many cases, allied with genius and creativity (Kessel, 1989). Psychiatrists of the late 1800s did not share the Romantic distrust of reason and sanity, but they were nevertheless inuenced by its interest in the inner world of the genius, the artist, and the madman. In 1872, the respected psychiatrist Ambroise-Auguste Tardieu suggested that the artistic productions of the insane, which had until that time been discouraged and ignored in asylums, could be used to understand the ways that individual patients constructed their realities. Later in the same decade, Paul-Max Simon suggested that patients art could be used in the differential diagnosis of melancholia, chronic mania, megalomania, general paralysis, dementia, and imbecility (Gilman, 1985; MacGregor, 1989). Under the inuence of Romanticism, then, psychiatrists and artists alike began to take greater interest in the art of 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. At the same time, artistic products of asylum inmates came under close scrutiny. Schizophrenic art in particular began to be encouraged, analyzed, and collected. As a result, hospitalized amateurs such as August Klett and Adolf Wo li were hailed as schizophrenic masters. By the middle of the 20th century, 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, whereas the Collection de lArt Brut, now in Lausanne, owes its existence to the artist Jean Dubuffet (Gilman, 1985; MacGregor, 1989; Prinzhorn, 1922/1995). The second trend in the depiction of the inner world of the mentally disordered involved professional artists depictions of mental states in general. At the beginning of the 20th century, in tandem with Freudian psychoanalysis and sometimes under its direct inuence, art movements such as Expressionism and Surrealism abandoned the goal of faithful

representation of external reality (Gilman, 1982). Each school had its own revolutionary ideals, but one common result of many of these agendas was the visual exploration of interior experiences such as emotional states, dreams, and psychopathology. Well-known examples include the anxiety suggested by the turbulent, orange sky in Edvard Munchs The Scream (1894); the melting clocks and barren sands of Salvador Dalis Persistence of Memory (1931); and the representation of a madmans delusion through the use of distorted sets and unconventional camera angles in the German Expressionist lm The Cabinet of Dr. Caligari (Wiene, 1919). The bodies of work that produced these depictions of disordered mental processes bear an interesting relationship to the art of the mentally ill. Iconoclasts in modern art movements were keenly interested in works produced by the insane. In particular, Expressionists revered van Gogh and viewed his mental illness as crucial to his greatest paintings, whereas Surrealists proudly emulated works produced by inmates of insane asylums. Outraged critics reacted to modern art by questioning the sanity of its practitioners. Among these critics were psychiatrists who assigned diagnoses to noted artists on the basis of analyses of their paintings and sculptures. As James MacGregor (1989) has noted, 20th century artists, art historians, and psychiatrists often proceeded in their endeavors with a supercial understanding of each others disciplines, which resulted in a considerable amount of amateurish and naive psychologizing (p. 350). What is ironic about this history of revolution and reaction is that the visual ideas of modern art movements, including their interest in the depiction of emotional states and disordered mental processes, are now a part of everyday popular culture. Visual references to mental disorder that include blurred images, tilted frames, uncanny settings, and the like often occurring in conjunction with stereotypic pictures of external appearanceare now commonplace in such diverse locations as horror movies, pharmaceutical ads, cartoons, magazine illustrations, and psychology textbooks.

The Uses of Interior Landscapes of Mental Disorder

In the epilogue to Seeing the Insane, a historical survey of stereotypes of the external appearance of the mentally ill, Sander L. Gilman (1982) noted the continuing presence of these stereotypes in many of the pictures in a modern textbook of psychiatry. Gilman also observed, alongside depictions of tradi-

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tional stereotypes of exterior appearance, an entirely new area of perception (p. 224). He gave two examples:
In one instance, the reader is presented with an image of the dismembered body of a clothes mannequin lying on an open space, with two minuscule gures running in the background. 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. In another, the picture of a female hugging three children while a male sits apart in the background illustrates a patients relationship to his parents and siblings. (p. 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. . . . In teaching aids today, this combination is not only accepted but expected (p. 224). A casual look at two or three textbooks of abnormal psychology easily conrms Gilmans (1982) observation: Pictures of disordered psychological processes as well as pictures produced by mentally ill individuals are easy to nd. Nevertheless, Gilmans commentary raises an interesting question: Why are interior landscapes of mental disorder not only accepted but expected (p. 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, more broadly, to understand the psychology of individual artists; to demonstrate a connection between mental illness and creative genius; and to illustrate the subjective experience of madness. All three of these functions have turned out to be problematic. From Tardieu and Simon in the 1870s to Prinzhorn (1922/1955) in the 1920s to the present day, the history of attempts to correlate artistic elements with diagnostic categories has been full of controversy and frustration (Gilman, 1985; MacGregor, 1989). During this time, mental health professionals have disagreed about whether artistic products have diagnostic usefulness. Those who afrmed the utility of art in understanding the psychology of the artist suffered notable embarrassmentsfor example, Cesare Lombrosos late 19th century use of paintings and drawings to illustrate moral degeneracy in both criminals and geniuses, followed a few decades later by the Nazis identication and suppression of degenerate art and artists. Modern psychodynamic observers of art, in the careful, erudite tradition of Hans Prinzhorn

and Ernst Kris, see the psychological analysis of art as useful in illuminating individual symbol systems (Gilman, 1985) but also caution that this project can only be undertaken with great care. Diagnosis, if relevant, should be established independently; the analyst must have a thorough knowledge of art history and a comprehensive grasp of relevant external factors, such as the artists life situations, therapist inuences, current and past artistic conventions, and relevant cultural stereotypes of depicting different types of individuals and mental processes. Once this thorough assessment is in hand, the analyst may venture interpretations based on the form and content of artistic works. This is a far cry from the earlier agenda of mapping artistic elements to specic diagnostic labels and mental processes. 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. The concept of the mad geniusan umbrella that covers not only practitioners of the visual arts but also poets, novelists, musicians, and scientistsis at least as ancient as Plato and Aristotle (Gilman, 1985; Kessel, 1989; MacGregor, 1989). Today, the hypothesis of a connection between mental disorder and creative genius remains controversial. Kraepelins (1921) suggestion that manic episodes of bipolar mood disorders disinhibit and enhance artistic cognitions and behaviors has modern proponents who claim empirical support (e.g., Andreasen, 1987; Jamison, 1989). Opponents of the bipolar hypothesis have countered with demonstrations that mania increases the quantity but not the quality of works produced, arguments that mental disorder in general decreases artistic output, and a suggestion that the madness genius connection is nothing more than one of many prevalent stereotypes of mental disorder (Kessel, 1989; Schoeneman & Marley, 1995; Weisberg, 1994). 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, professional publications, and the mass media (Gilman, 1982; MacGregor, 1989). Mental health and art professionals alike have used these images to depict the subjective experience of mental disorder for lay audiences. Some observers applaud the proliferation of interior landscapes of mental disorder as having the potential to promote understanding, acceptance, and a reintegration into society of the mentally ill (e.g., MacGregor, 1989). However, even if images of the internal world of the mentally ill are intended to

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promote empathy, 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). Purveyors of internal landscapes of mental disorder could also inadvertently promote degeneracy theories, the mad artist stereotype, or the Romantic idea of insanity as a marvelous state of creative freedom and unrestrained imagination (MacGregor, 1989, p. 282).

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. Interior landscapes of mental disorder appear in two varieties: Process pictures are professional artists simulations of the inner experience of disordered mental processes, and product pictures are works produced by mentally disturbed individuals. Although we have focused so far only on artworks as products of mental disorder, two other types of artifacts can also t into this category: drawings produced as a part of directed psychological assessment, and writing samples. The commonality between process and product pictures lies in their use as windows into the psyches of a particular class of the Other, the mentally ill. As is the case with many conceptual distinctions, boundaries can be fuzzy. Interior landscapes of mental disorder often contain aspects of exterior appearancethink, for instance, of a van Gogh self-portrait or a photograph of a person looking at a distorted reection in a mirror. In addition, process and product pictures are not always clearly separable: A reproduction of Edvard Munchs 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. As this example suggests, the distinction between process and product pictures often depends on the way that a picture is used by its exhibitor (Berger, 1972). We also suggest three uses of interior landscapes of mental disorder. The diagnostic function uses artistic products to classify and understand the unconscious processes of the artist, whereas the madness creativity function uses these artifacts as evidence of a connection among mental disorder, creativity, and genius. The empathic function uses both process and product pictures as ways of representing what it is like to experience mental disorder. To study interior landscapes of mental disorder, we needed a source of such pictures. 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 sufcient number of interior landscapes of mental disorder to conrm Gilmans (1982) earlier sightings and pique our interest. In this report, we turn our attention for the rst time to pictures of the interiority of mental illness in these textbooks to answer questions about their prevalence and characteristics. Our methodology is both empirical and interpretive: We derived our sample and coded pictures using content analytic procedures, and we inspected pictures and captions to interpret the implicit and explicit messages that they contained.

Content Analysis
Our sample of pictures came from all 38 textbooks of abnormal psychology published in the United States between 1986 and 1996. These books contained 7,229 pictures of peoples external appearance or interior experience. Of these, 673 (9%) are included in our sample of interior landscapes of mental disorder. Carly M. Henderson and Vaunne M. Weathers independently sorted each picture into a number of predened categories (Schoeneman, Brooks, & Gibson, 1995). Their percentage of agreement was our estimate of interrater reliability. All disagreements were resolved through discussion, with Thomas J. Schoeneman as the nal arbiter. We coded the initial sample of 7,229 pictures as depicting exterior appearance, interior mental processes, or both, with an interrater reliability of 98%. We then coded each of the 673 pictures that depicted interiority on a number of dimensions. First we determined interior picture typethat is, process versus productwith an interrater agreement of 97%. Pictures rated as products were further categorized as art (e.g., drawings and paintings), writing samples (e.g., copies of letters), results of formal assessment (e.g., gure copying, directed drawing), or mixed (e.g., illustrated letters), with an agreement rate of 95%. All process and product pictures were coded for psychological status (normal vs. abnormal; 98%) and diagnosis (26 categories, reduced via combination to 18 for this report; 93%).

Sample Characteristics
Our sample yielded an average of 17.7 interior landscapes of mental disorder per textbook (SD 11.4; range 2 43). There were 207 process pictures (31%). The remaining 69% of the sample,

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the product pictures, included 322 artworks (48% of the total sample), 80 depictions of assessment drawings (12%), 54 writing samples (8%), and 10 art writing mixtures (1%). An overwhelming majority of these pictures represented abnormal psychological processes (f 620; 92% of the sample of 673 pictures).

Diagnostic Features
Table 1 gives frequencies associated with various diagnostic categories. By a wide margin, interior landscapes of schizophrenia and other psychoses were the most frequent in our sample (146 pictures, 22% of the sample; 138 of these depicted schizophrenia). Three quarters of these pictures were artistic products. Table 1 also lists the dominant picture types for each diagnosis. An alternative way to describe the diagnostic features of our sample is to look at which disorders are characteristic of each picture type. Process simulations were exclusively used to depict possession states, somatoform disorders, and dissociative disorders other than dissociative identity disorder (i.e., amnesia, fugue, and depersonalization) and were predominant for anxiety disorders, personality disorders, and nondisordered subjects. Art was the most prevalent picture type in 10 diagnostic categories, especially for schizophrenia, paranoia, childhood psychosis, and unspecied disorders. 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. Written products were predominant for no disorder category but were encountered with some frequency for mood disorders, paraphilias and transsexualism, and childhood disorders. Finally, 9 of the 10 pictures in the mixed category were art and writing combinations; 8 of these were attributed to schizophrenics.

Originators, Works, and Collections

Table 2 presents originators of interior landscapes of mental disorder whose works appeared 5 or more times in our sample. Several features of this catalog deserve comment. Turning rst to originators whose artworks are used to represent their disorders, we nd Vincent van Gogh to be foremost: His work appears 12 times in our sample. Furthermore, of the seven different van Gogh paintings we encountered, six are self-portraits. These works, including most prominently Self-Portrait With Bandaged Ear (1889; 5 times), are used to show the exterior appearance of this mad artist as ltered through his own disordered mental processes of bipolar disorder (5 times), schizophrenia (1 time), epilepsy (1 time), or an unspecied disorder (4 times). In the seventh work, the well-known The Starry Night (1889; Figure

Table 1 Diagnostic Categories Represented by Interior Landscapes of Mental Disorder

Disorder Schizophrenia/psychosis OBS/mental retardation Childhood disorders Other/not specied 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), writing (10), process (10) Process (40) Art (22) Process (32) Process (11), art (10) Art (12) Process (16) Art (7), writing (6) Art (9) Process (7) Art (7) Art (3), process (2) Process (3) Process (35)

Note. OBS organic brain syndrome; DID dissociative identity disorder. a Numbers in parentheses indicate frequency of picture type.

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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 li 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. 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. 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, 1 art Art Art Art Art Art Process Process Art Art Art Art Assessment Process Art Process Writing 4 writing, 1 assessment Art Art Art Representative work Self-Portrait with Bandaged Ear, The Starry Night (see Figure 1) St. 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, Despair, The Dead Mother & the Child Flowers-in-vase series (paranoia) Worm Holes etc. (PC) Rooster (autist savant) Mechanical boy (autism) Cat series (psychosis) Exorcism scene Depictions of phobias St. Adolf-Giant-Creation (AB; see Figure 5) Drawings of sadistic fantasies Windmill series (Alzheimers disease) Elizabeth & the Beasts BenderGestalt Test copies Moonstruck women (18th century) Untitled (PC) Dr. Wurmbrandt (head-roasting cure) Letter/postcard to Jodie Foster Photo of dyslexic childs writing Universe Inversion (PC) Paintings of alcoholism Maisons (AB)

Note. Frequencies are the frequency with which the originators work appeared in 38 textbooks; the number of works is the number of different titles by the originator that appear. The Representative work column gives titles or descriptions of one or more of the originators works and includes indicators of two sources: the Prinzhorn Collection (PC) and the Collection de lArt Brut (AB). DID dissociative identity disorder. a Originators work appeared in multiple editions of only one textbook.

1), 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 prominence of van Goghs work in our sample supports MacGregors (1989) suggestion that, outside the discipline of art history, van Gogh remains the quintessential exemplar of the mad artist (cf. Schoeneman & Marley, 1995). The mirror image of the mad artist is Prinzhorns (1922/1995) schizophrenic master or, more generally, the mentally disturbed individual who develops artistic excellence, often during hospitalization. Several of these masters are included in Table 2: August Klett, Adolf Wo li, Franz Karl Buhler, Joseph Sell, and Aloise Wey. 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 38) and the Collection de lArt Brut (f 47). Taken together, these two institutions account for 13% of the pictures in our sample, far more than any other source acknowledged in textbooks picture credits. Table 2 also contains the artworks of mentally disordered amateurs other than those represented in the Prinzhorn and Art Brut collections. These include portraits of the alters of people diagnosed with dissociative identity disorders (Chris Sizemore, Billy Milligan), drawings by autistic children (Nadia, Joey), series of paintings depicting the progression of paranoid schizophrenia (Anonymous 1) and Alzheimers disease (Anonymous 4),

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Figure 1. Vincent van Gogh, The Starry Night (1889). A textbook in our sample noted that Vincent Van Gogh probably suffered from bipolar disorder and presented this picture because it expresses the expansive, creative quality of [the artists] mania (Wilson, Nathan, OLeary, & Clark, 1996, p. 199). Van Gogh (18531890) used exaggerated depictions of nature to express human emotions; in this regard he was a forerunner of German Expressionism (ca. 19051930). The Expressionists, in fact, adopted van Gogh as a kind of patron saint who, through his madness and creative genius, promoted the movements ideal of challenging conventional perceptions of reality. Over the course of the 20th century, van Gogh became both a contender for the position of the most widely known European artist (McQuillan, 1989, p. 7) and like a site where discourses on madness and creativity converge (p. 9; see also Chilvers et al., 1994; MacGregor, 1989). Oil on canvas, 29 3614 in. Acquired through the Lillie P. Bliss Bequest. (472.1941) Copyright by The Museum of Modern Art/Licensed by SCALA/Art Resource, New York.

drawings of the sadistic fantasies of an autoerotic asphyxia fatality (Anonymous 3), and paintings by a schizophrenic (Moudine) and an alcoholic (W.). In addition to works of art produced by the mentally ill, Table 2 contains examples of two other kinds of product pictures: writing samples and assessment results. The written materials in Table 2 consist of two of John Hinckley Jr.s messages to Jodie Foster prior to his presidential assassination attempt (reproduced ve times) and a photograph of a dyslexic

childs printing containing reversed and transposed letters (f 4). In the sample as a whole, 44 of 54 (81%) written products and 9 of 10 artwriting mixtures appeared anonymously. The most prominent of patients assessment products in our sample was a set of BenderGestalt Test gure copies taken from Lacks (1984) that appeared ve times (Anonymous 5 in Table 2). In fact, the majority of the 80 assessment pictures in our sample were gure copy and drawing tasks from tests of

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cognitive and intellectual functioning: These included 39 BenderGestalt Test copies (49%), 27 other gure copies (34%), and 7 gure drawing tasks (9%). The remaining 8% consisted of six Draw-APerson (Aiken, 1995) results and one reproduction of a self-monitoring journal. Assessment pictures were produced primarily by patients with organic brain syndromes or mental retardation (f 63; 79%) and developmental disorders (f 10; 12%). All assessment pictures in the sample were anonymous. Table 2 also contains frequently occurring pictures that are used as simulations of disordered psychological processes. Note that the process pictures in Table 2 are a mixture of works by professionals whose names are given in captions (Benvenuto, Chast, Munch, and Vassos) and of the more anonymously presented images supplied by picture services (Anonymous 2 and 6). In our sample as a whole, 87 pictures by 35 notable artists and cartoonists constituted 42% of all process pictures. The remaining 120 came from the collections of picture services.

Too much space would be needed to reproduce all of these captions, but Table 3 displays 10 that we can use as examples. On the basis of an examination of the random sample of 30 captions and of the complete sample, we offer the following generalizations. Process simulations, by denition, satisfy the empathic function of showing what it is like to have a particular disorder (Captions 1 and 2 in Table 3), although they can also express the diagnostic function if the process as depicted is claimed to be typical of a particular disorder (Caption 3). Reproductions of patients writing and assessment results seem to serve the diagnostic function almost exclusively (Captions 4 and 5). Artworks are versatile: They see service as expressions of the artists 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); artworks also seem to be the primary locus of correlations drawn between mental disorder and artistic productivity (Captions 9 and 10).

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. 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, visual simulations of psychological processes such as anxiety and delusions, exorcism scenes, cartoons, handwriting samples, BenderGestalt Test gure copies and the likeraises a question about whether any pictorial commonalities could possibly be discovered. In fact, they can: Depictions of psychological interiority seem to cluster into two varieties, 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. In art history and criticism, the term shifted meanings from the 17th through 19th centuries: The word grotesque, originating as a technical term designating a late Roman type of decoration and a Renaissance decorative style based upon it, came to imply whatever is incongruous with the accepted norm whether in life or in art (Chilvers, Osborne, & Farr, 1994, p. 222). Wolfgang Kayser (1963), in his book The Grotesque in Art and Literature, was more specic: The grotesque is a structure. . . . Its nature could be summed up in a phrase that has repeatedly suggested itself to us: THE GROTESQUE IS THE ESTRANGED WORLD (p. 180, 184; capitalization in the original). Thus, the viewer of a grotesque is likely to react using descriptions ranging from strange and odd, 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, empathic, and madness creativity functions of interior landscapes of mental disorder. It was, in fact, our impression that captions almost always express one or more of these three functions. In an attempt to pursue this impression (albeit somewhat informally) and to generate examples for use in this report, we drew a random sample of 34 pictures (5% of the total sample). All 30 of the captions attached to these pictures fullled one of the three functions; 11 presented two functions. By our count, there were 17 instances in which captions mentioned the diagnostic function, 13 in which they mentioned the empathic function, and 11 in which they mentioned the madness creativity function.

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Table 3 Examples of Captions and the Functions They Serve

Caption 1. In the various forms of dissociative disorders, people appear to be trying to run away or distance themselves from the source of their anxiety, never realizing the source of their anxiety is within themselves (Duke & Nowicki, 1986, p. 257). 2. The cartoonist Roz Chast has captured the thinking that is typical of a depressed person (Sarason & Sarason, 1987, p. 277). 3. An LSD trip. LSD is an hallucinogenic drug that gives rise to a vivid parade of colors and visual distortions. Some users have claimed to have achieved great insights while tripping, but when the drug wears off, they usually cannot summon up or implement these insights (Nevid, Rathus, & Greene, 1994, p. 343). 4 Learning to write requires a certain degree of coordination and cognitive skill. Children develop these skills at different rates. Those who develop them later than average often are at a disadvantage in kindergarten and in later school years (Sarason & Sarason, 1987, p. 431). 5. Two gure drawings illustrating the defensive hysteroid (left panel) and the defended depressive (right panel) sides of a character neurotic personality (Willerman & Cohen, 1990, p. 164). 6. This painting is typical of artwork produced by schizophrenics. (Collection de l Art Brut, Lausanne, Switzerland) (Meyer & Salmon, 1988, p. 231). 7. Paintings by schizophrenic patients that suggest the disturbance of affect and sense of self that are often present with the disorder . . . . (Bottom) The partly hidden ghostlike gure painted by this patient suggests depersonalization and loss of identity (Bootzin & Acocella, 1988, p. 360). 8. How it feels to have an epileptic seizure. This drawing was made by a victim of grand mal epilepsy. Many epileptics have visual premonitions of an oncoming seizure, called auras. These experiences resemble dreams, although the individual is still fully conscious. Terrifying as it often is, an aura can help steel an epileptic for the ordeal of a seizure (Goldstein, Baker, & Jamison, 1986, p. 318). 9. [The Collection de l Art Brut] provides an extraordinary glimpse into the inner lives and private visions of cultural outsiders and conrms Dubuffets sense of the profound talents that often lie within those who are, for one reason or another, considered to be abnormal (Carson & Butcher, 1992; inside front cover). 10. The artists [in the Prinzhorn Collection] were mentally ill patients, with no formal artistic training, who lived during the late 1800s to early 1900s. They were most often diagnosed as schizophrenic and did not express themselves artistically until after the onset of their illness. A remarkable aspect of this art is that it was produced spontaneously, not as a part of a therapy program, by people living in socially isolated, unstimulating environments (Sue, Sue, & Sue, 1986, p. 427). 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: madnesscreativity function

Art: madnesscreativity function

of a continuum, to fantastic, bizarre, and weird, on the other. 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, surrealism, and naivete . The expressionist trend in interior landscapes of mental disorder is characterized by distortions and exaggerations of line, form, color, shadow, and perspective. In the history of art, this trend can be found in the works of Vincent van Gogh and Edvard Munch near the turn of the 20th century,

in the Expressionist movement in German art circa 19051930, and in German Expressionist lms of the 1920s and American horror movies and lms noir of 1930 1960. In this tradition, artists used distortions of the physical world and human form to express emotions, passions, anxieties, and psychopathologies, sometimes autobiographically (Chilvers et al., 1994). Examples of the expressionist trend in our sample include pictures by professional artists such as van Gogh, Munch, James Ensor, Henry Fu ssli, and John Vassos (see Figures 1 and 2) and photography that uses techniques such as multiple exposure, highcontrast shadowing, zoom effects, and blurring to

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Figure 2. John Vassos, Acrophobia (1931). 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, published in 1931 by the New York rm of Covici, Friede (see also Vassos, 1976). Illustration courtesy of the University of Syracuse Library, Department of Special Collections.

suggest experiences such as hallucination, dissociation, and other pathological processes (see Figure 3). The surrealist approach is characterized by a fascination with the bizarre, the incongruous, and the irrational (Chilvers et al., 1994, p. 482). The Surrealist movement in the 1920s and 1930s was heavily inuenced by the psychoanalytic conception of an irrational unconscious; artists and writers of this school tried to fuse the realm of dreams and halluci-

nations with external reality, which resulted in highly detailed representations that made no rational sense. Our sample includes pictures by Surrealists such as Salvador Dali, Rene Magritte, Yves Tanguy, and Wilfredo Lam alongside more recent depictions, 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). Paintings and drawings by schizophrenic

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Figure 3. Dan McCoy, Down the Road. The expressionist zoom effect in this photograph is used to depict the interior experience of psychogenic fugue in three textbooks in our sample. Copyright by Dan McCoy/Rainbow.

(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, 1989, p. 3) that are lacking in conventional expertise in representational skills (Chilvers et al., 1994, p. 439). In naive painting, for example, colors are characteristically bright and non-naturalistic, perspective nonscientic, and vision childlike or literal-minded (Chilvers et al., 1994, p. 439). 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, members of primitive societies, and social outsiders (including the mentally ill). In fact, naive art has been of considerable interest to Expressionists, Surrealists, and artists such as Jean Dubuffet, the founder of the Art Brut collection, in their efforts to break away from social and artistic conventions and approach a purer, unconstrained creativity (cf. Caption 9 in Table 3). In our sample, naive characteristics can be seen primarily in the works of mentally disordered masters and amateurs (Figures 5 and 6). Again, the common thread that we have identied in pictures that show expressionist, surrealist, and naive characteristics is incongruity: These pictures contain features that depart from artistic, social, and

perceptual expectations of realism. Not every internal landscape of mental disorder ts into the category of the grotesque, however. There are some that strive for an apparent naturalism. Naturalism in interior landscapes of mental disorder. We use the term naturalism to describe an approach to art in which the artist endeavors to present objects as they are empirically observed, rather than in a stylized or conceptual manner (Chilvers et al., 1994, p. 351). Three subsets of the pictures in our sample are free of distortions and incongruities. The rst 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, gure copies, and so on that seem to be presented to the reader as empirical data. There are, of course, distortions present in the printing of dyslexic children and the gure copies of patients with brain lesions, but the emphasis in these pictures seems to be on normative errors rather than on strangeness or incongruity. A second type of naturalistic picture involves a more or less realistic depiction of a persons exterior appearance along with the inclusion of a thought bubble containing words or pictures. The earliest works of this type include all 40 of the possession and exorcism scenes in our sample (6%; see Table 1);

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Figure 4. Michael Weisbrot, Mindys Cat. This picture, with its surreal superimposition of eyes and mouths on a white cat, appears in a textbook with the following caption: Everyday objects can make some unexpectedly frightening changes as schizophrenics experience hallucinations (Duke & Nowicki, 1986, p. 163). The photograph was originally produced for an exhibit at the Childrens Museum of Manhattan that had nothing to do with mental illness (M. Weisbrot, personal communication, September 2, 2003). Photograph copyright by Michael Weisbrot.

these pictures date from the 16th century and usually present a demon exiting through the mouth or ear of the patient (see Figure 7). The next manifestation of pictures containing thought bubbles occurred with the work of 19th century caricaturists such as George Cruikshank and Honore Daumier; these artists were the forerunners of the 20th century cartoonists in our sample, such as Roz Chast, Sidney Harris, and Gary Larson. In our sample, 32 pictures (5%) are 19th and 20th century cartoons involving thought bubbles. The nal 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 artists execution or textbook authors intended use. Examples include paintings of George Tooker and Edward Hopper, which are said to express the loneliness and alienation of modern life using starkly realistic subjects and styles (Chilvers et al., 1994). There are only six process pictures in our sample (1%) that are rendered in a naturalistic style. It is possible to estimate the relative proportions of grotesque and naturalistic depictions in our sample of interior landscapes of mental disorder. As noted above, 32% of the pictures in our sample belong to one of the three categories of naturalistic pictures. The remaining 68% are artworks and artwriting mixtures; process pictures by artists known to use

expressionist, surrealist, or naive styles; and anonymously produced process pictures from picture services. Our experience in scrutinizing these latter pictures suggests that an overwhelming majority conform to the grotesque style of interior depictions. An approximate and conservative estimate therefore puts the proportion of grotesque pictures in our total sample at 60%.

Discussion
There are a number of ndings in this study that warrant further discussion, but space considerations do not permit us to be exhaustive. In the balance of this article we focus on three questions raised by our ndings: 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 identied as the prototypical mental disorder in a survey of modern Americans implicit categories of psychiatric diagnosis (Schoeneman, Segerstrom, Grifn, & Gresham, 1993). This public awareness of schizophrenia has a

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Figure 5. Adolf Wo li, Saint Adolf Portant des Lunettes, Entre les Deux Villes Geantes Niess et Mia (1924). This work by a schizophrenic master shows both surrealist incongruities and the unconventional techniques of naive art. Wo li (1864 1930) was the subject of a major exhibition at the American Folk Art Museum in 2003 (Spoerri, Baumann, & Wo li, 2003). Colored crayons on paper, 51 68 cm; photo by Henri Germond, Lausanne; from the Collection de lArt Brut, Lausanne.

parallel in professional interest. Many abnormal psychology textbooks devote two chapters to this disorder, whereas other chapters deal with clusters of related disorders. It is not surprising that schizophrenia is represented in textbooks by more pictures of sufferers than any other disorder (Schoeneman, Gibson, Brooks, Jacobs, & Routbort, 1992; Schoeneman & Marley, 1995). In addition, psychiatric interest in the art of the mentally ill has often taken the form of analysis of the works of schizophrenic masters (MacGregor, 1989). For these reasons, it is not surprising that schizophrenia was the preeminent diagnosis in our sample of interior landscapes of mental disorder. One could also assert that schizophrenia receives so much attention because it is, in fact, the most severe mental disorder. A few moments of consider-

ation, however, render this statement problematic. In terms of number of people affected, impact on family members and other people, cost to the economy, and disorder-related deaths, depressive disorders and alcoholism surpass schizophrenia. If we consider loss of function and capacity for independent living, schizophrenia has rivals in Alzheimers disease and other organic brain syndromes and in developmental disorders such as autism and mental retardation. Schizophrenia is clearly an extremely debilitating disorder, but part of its perceived severity may derive from a larger social ideology. We have suggested elsewhere (Schoeneman et al., 1994) that schizophrenia is both a violation of Western conceptions of the individual, in terms of loss of rationality and personal agency, and a major example in the public mind of the centuries-old stereotypical gure of active mad-

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Figure 6. In this photograph of Chris Sizemore, who was given the pseudonym of Eve in The Three Faces of Eve, the viewer sees both the external appearance of a famous case of multiple personality disorder and the interior experience of dissociative identity disorder. The latter is represented by the three-faced gure in Sizemores painting, a work that exemplies techniques of naive art. Photo by Gerald Martineau. Copyright 1975, The Washington Post. Reprinted with permission.

ness, the maniac. The prominence of interior landscapes of schizophrenia in our sample may reect the disorders prototypical status in this culture. The current study adds interesting details concerning the cultural imagination of schizophrenia. There seems to be a strong impulse on the part of textbook authors and their audiences, teachers and students, to want to look into the mind of the schizophrenicfar more so than for any other disorder. 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, a place that cannot be directly observed but can only be inferred from the unusual speech, behavior, and appearance of the patient. The heavy use of schizophrenic art, a body of work noted for its strangeness, 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. The connections suggested between schizophrenia and a turbulent, passionate core that erupts into artistic expression may be seen as evidence of a strain of Romanticism that inhabits these textbooks, dominated as they are by modernist science, as well as the culture in general. This Romantic outcropping may be the same tendency that made it possible in the 1960s for R. D. Laing to propose an analogy between schizophrenia and LSD trips and that fuels continued interest in Freudian and Jungian psychoanalysis (Gilman, 1985; MacGregor, 1989).

Uses and Effects of Interior Landscapes of Mental Disorder

In our examination of pictures and captions from current abnormal psychology textbooks, we found

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Figure 7. Girolamo di Benvenuto, St. Catherine Exorcising a Possessed Woman (ca. 1500 1510). A painting in the naturalist style, with the interior process represented by the demon exiting from the possessed womans ear. Oil on panel, transferred to Masonite; Denver Art Museum; copyright by Bettman/CORBIS.

that the diagnostic, madness creativity, and empathic functions are operative, but we havent 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, but the pictures semiotics may convey information that is not intended (Berger, 1972; Gilman, 1982; Schoeneman et al., 1994). Let us briey consider the three functions with an eye toward this question of unintended messages. The diagnostic function. Appropriate uses of pictures for the diagnostic function in our samples include the display of BenderGestalt Test and other gure copy assessment results used to illustrate brain dysfunction and perhaps some of the writing samples that show suicide notes or dyslexic errors. We call the inclusion of these pictures appropriate because they have demonstrated reliability and validity as diagnostic aids (Aiken, 1995). At the other extreme, it is inappropriate to display handwriting samples, 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, 1995; MacGregor, 1989). In general, 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, and no authors made the claim that people with different disorders produce differentially characteristic drawings, paintings, or sculptures. Some authors, in fact, provided disclaimers that counteract the idea that art can have diagnostic utility. Nevertheless, we suspect that readers may be receiving unintended messages about the diagnosticity of artworks. In some cases, captions assert that a painting is typical of a particular disorder or that an artistic production is a manifestation of specic symptoms of a disorder (see Captions 6 and 7 in Table 3). In other, apparently more innocuous cases, an artwork is identied by title and artist and perhaps a diagnostic label and a brief case history. These pictures do not appear to suggest the diagnosticity of artworks but may, in fact, do so: The reader may generalize from the individual case to the diagnostic group, 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. Authors verbal disclaimers, if given, may not be suf-

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cient to counteract impressions of the diagnosticity of patients artworks that are given by the vivid reproductions that appear within the text (Nisbett & Ross, 1980). 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. If we were to present an array of artworks produced by Expressionist, Surrealist, 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 descendantswe suspect that laypersons and mental health professionals would not be able to reliably distinguish the works that were the products of troubled psyches. Textbooks may, however, be giving the impression that such a distinction is possible. If readers of abnormal psychology textbooks do infer that there are distinctive differences in abnormal artworks, might they not also wonder if all nonrealistic styles of art are representative of eccentric and even disordered minds? The madness creativity function. In visual terms, the connection presented in textbooks of abnormal psychology between mental disorder and creativity is striking. These texts are full of reproductions of paintings by van Gogh and Munch, portraits of multiple personality disorder alters by Chris Sizemore and Billy Milligan, drawings by autistic savants, and pieces from the Prinzhorn and Art Brut collections. Eighteen textbooks (47%) in our sample assembled three or more artworks within chapters on schizophrenia, and four (11%) mounted this kind of exhibition throughout the entire volume as chapter openers. Picture captions indicate that authors sometimes use these artworks to fulll the diagnostic and empathic functions (see Captions 6 9 in Table 3), but verbal descriptions also draw attention to the creative talents of disordered individuals and groups (see Captions 9 and 10 in Table 3). These latter captions generally do not explicitly claim that there is a substantial correlation or causal connection between artistic talent, creativity, or genius, on the one hand, and either specic mental disorders or mental illness in general, on the other. Rather, captions usually take one of two forms: X was an individual with Disorder Y who showed great artistic talents, or Individuals who suffer from Y sometimes show great artistic talents. Nevertheless, 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 geniusthe idea that Great wits are sure to madness near allied/And thin partitions do their bounds divide (John Dryden, cited in Kessel, 1989, p. 197). Readers may also come to believe the obverse of the mad artist stereotypethat is, that latent creativity is released when a person becomes aficted by a disorder such as schizophrenia (Gilman, 1985; Sontag, 1990). It is interesting to note that the Kraepelinian hypothesis, which connects creativity to bipolar manic and hypomanic episodes, is generally not associated with the pictures in our sample. Sixteen (42%) textbooks mentioned the bipolar hypothesis. Of the 22 pictures that accompanied the presentation of the hypothesis, 19 were portraits; only 3 were interior landscapes of mental disorder. The portraits included eight authors, ve composers, ve politicians, and an actress. The 3 remaining pictures that were associated with the visual arts were also a part of our sample: They were paintings by van Gogh. The empathic function. Textbook authors denitely do intend that process simulations and artworks should convey to viewers some idea of the experience of mental disorder (see Captions 13 and 79 in Table 3). The question then arises about how well these pictures serve the empathic function. More specically, if we construe interior landscapes of mental disorder as assemblages of visual metaphors for disordered mental processes, 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 viewers perception and action beyond sympathetic understanding. These questions may seem odd at rst glance. On the one hand, it seems entirely obvious to equate, for example, darkness and depression. On the other, it seems strange to question the potential impact of these metaphors beyond their descriptive uses: Are they not the visual equivalents of verbal metaphors, gures of representation that are like gures 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 authors made three assertions that are relevant here. In the rst place, our thinking and speech are so full of metaphors that we are generally unaware of them. To continue with our previous example, de-

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pression is not literally darkness or dark colored, but we use the analogy so much that the pairing seems natural. 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. Depression is (like) darkness coexists with other metaphors that link depression to downward directionality, heaviness, and foul weather (to name a few), and darkness has other connotations in our culture besides disordered mood (e.g., night, evil). Finally, Lakoff and Johnson (1980) and others have asserted that metaphors are not just gures of speech (or representation): They have consequences for individual and social behaviors. Two examples demonstrate this. Thomas Szasz (1960) has pointed out that the metaphor Abnormal behavior is (like) illness absolves people from responsibility for their actions, thus setting up very real conicts between legal and medical authorities and the social groups in which the authorities are embedded. In addition, Susan Sontag (1990) has suggested that warfare metaphors of invasion, attack, and counterattack used to describe the onset and treatment of cancer and AIDS cause unnecessary distress to people who have these disorders. 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. It is possible, of course, for verbal and visual metaphors to promote empathy and sympathy while simultaneously maintaining the distance between selfthe viewerand the Other. For instance, we can consider a recent analysis of William Styrons (1990) rhetorical strategies in his memoir of major depression, Darkness Visible: A Memoir of Madness. Styron rst described depression using metaphors that seem calculated to increase the distance between normality and depression: Depression is down, in, and away and a sequential process of suffering and adversity that is a form of malevolence and annihilation. In contrast, 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, out, and through, a sequential process of return to a life of goodness and light (Schoeneman, Schoeneman, & Stallings, 2004, p. 325). In the realm of images, relevant research has examined the depiction of AIDS and it sufferers. These analyses have found that the more liberal news media as well as college-level textbooks, venues that are sympathetic to victims of this disorder, neverthe-

less continue to anchor AIDS pictorially to concepts of death, alienness, victimization, culpability, and otherness (Gilman, 1988; Schoeneman, Schoeneman, & Obradovic, 2002). 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. A thorough examination of visual metaphors of mental disorder and their interconnections and action consequences is beyond the scope of this article. We have, however, 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. 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. If the grotesque is the estranged world (Kayser, 1963, p. 184), 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.

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. One could ask whether this extreme particularity might limit the topics interest to psychiatrists and psychologists. Three points seem worth making in this regard. First, visual depictions of the experience of mental illness are not limited to a specic kind of psychology textbook: They are easily spotted in such nonpedagogical venues as advertising and entertainment, and they are clearly a feature of several important Western art movements of the late 19th and 20th centuries. Second, these stereotypic depictions do not exist in isolation. They are part of a web of meanings that include other aspects of stereotypes of mental disorder (attitudes, narrative themes, and depictions of external appearance) and cultural constructions of the Other for the purposes of explaining misfortune and dening the good by contrast (Gilman, 1982; Schoeneman et al., 1994). Finally, 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. If this is so, depictions of the experience of madness are blueprints for social behavior, and knowledge of

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SCHOENEMAN, HENDERSON, AND WEATHERS Lacks, P. (1984). Bender-Gestalt screening for brain dysfunction. New York: Wiley. Lakoff, G., & Johnson, M. (1980). Metaphors we live by. Chicago: University of Chicago Press. MacGregor, J. M. (1989). The discovery of the art of the insane. Princeton, NJ: Princeton University Press. McQuillan, M. (1989). Van Gogh. London: Thames and Hudson. Meyer, R. G., & Salmon, P. (1988). Abnormal psychology (2nd ed.). Boston: Allyn & Bacon. Nevid, J. S., Rathus, S. A., & Greene, B. (1994). Abnormal psychology in a changing world (2nd ed.). Englewood Cliffs, NJ: Prentice Hall. Nisbett, R., & Ross, L. (1980). Human inference: Strategies and shortcomings of social judgment. Englewood Cliffs, NJ: Prentice Hall. Prinzhorn, H. (1995). Artistry of the mentally ill. Berlin: Springer-Verlag. (Original work published 1922) Rabkin, J. G. (1972). Opinions about mental illness: A review. Psychological Bulletin, 77, 153171. Sarason, I. G., & Sarason, B. R. (1987). Abnormal psychology: The problem of maladaptive behavior (5th ed.). Englewood Cliffs, NJ: Prentice Hall. Scheff, T. J. (1966). Being mentally ill. Chicago: Aldine. Schoeneman, T. J., Brooks, S., & Gibson, C. (1995). Picture coding of abnormal psychology textbooks. Unpublished manuscript, Lewis and Clark College, Portland, OR. Schoeneman, T. J., Brooks, S., Gibson, C., Routbort, J., & Jacobs, D. (1994). Seeing the insane in textbooks of abnormal psychology: The uses of art in histories of mental illness. Journal for the Theory of Social Behaviour, 24, 111141. Schoeneman, T. J., Gibson, C., Brooks, S., Jacobs, D., & Routbort, J. (1992, April). Seeing the insane in textbooks of abnormal psychology: I. Diagnosis and gender in visual stereotypes of mental illness. Paper presented at the meeting of the Western Psychological Association, Portland, OR. Schoeneman, T., J., & Marley, C. (1995, July). Whos who in textbooks of abnormal psychology, 1986 1995: Pictures of notable heroes, villains, and victims. Paper presented at the meeting of the American Psychological Society, New York. Schoeneman, T. J., Schoeneman, K., & Obradovic, J. (2002, June). Social representations of AIDS: Pictures in abnormal psychology textbooks, 1984 2001. Paper presented at the meeting of the American Psychological Society, New Orleans, LA. Schoeneman, T. J., Schoeneman, K. A., & Stallings, S. (2004). The black struggle: Metaphors of depression in Styrons Darkness Visible. Journal of Social and Clinical Psychology, 23, 325346. Schoeneman, T. J., Segerstrom, S., Grifn, P., & Gresham, D. (1993). The psychiatric nosology of everyday life: Categories in implicit abnormal psychology. Journal of Social and Clinical Psychology, 12, 429 453. Sontag, S. (1990). Illness as metaphor and AIDS and its metaphors (combined ed.). New York: Anchor.

these stereotypes may be crucial in challenging the stigmatization of the mentally ill (Corrigan & Penn, 1999).

References
Aiken, L. R. (1995). Personality assessment: Methods and practices (2nd ed.). Go ttingen, Germany: Hogrefe & Huber. Andreasen, N. C. (1987). Creativity and mental illness: Prevalence rates in writers and their rst-degree relatives. American Journal of Psychiatry, 144, 1288 1292. Berger, J. (1972). Ways of seeing. Harmondsworth, Middlesex, England: BBC/Penguin. Bootzin, R. R., & Acocella, J. R. (1988). Abnormal psychology: Current perspectives (5th ed.). New York: Random House. Carson, R. C., & Butcher, J. N. (1992). Abnormal psychology and modern life (9th ed.). New York: HarperCollins. Chilvers, I., Osborne, H., & Farr, D. (1994). The Oxford dictionary of art. Oxford, England: Oxford University Press. Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765776. Duke, M. P., & Nowicki, S. (1986). Abnormal psychology: A new look. New York: Holt, Rinehart & Winston. Gerbner, G., Gross, L., Morgan, M., & Signorelli, N. (1988). Health and medicine on television. New England Journal of Medicine, 305, 901904. Gilman, S. L. (1982). Seeing the insane. New York: Wiley Interscience/Brunner/Mazel. Gilman, S. L. (1985). The mad man as artist: Medicine, history and degenerate art. Journal of Contemporary History, 20, 575597. Gilman, S. L. (1988). Disease and representation: Images of illness from madness to AIDS. Ithaca, NY: Cornell University Press. Goldstein, M. J., Baker, B. L., & Jamison, K. R. (1986). Abnormal psychology: Experiences, origins, and interventions. Boston: Little, Brown. Hyler, S. E., Gabbard, G. O., & Schneider, I. (1991). Homicidal maniacs and narcissistic parasites: Stigmatization of mentally ill persons in the movies. Hospital and Community Psychiatry, 42, 1044 1048. Jamison, K. R. (1989). Mood disorders and patterns of creativity in British writers and artists. Psychiatry, 52, 125134. Kayser, W. (1963). The grotesque in art and literature (Ulrich Weisstein, Trans.). New York: Columbia University Press. Kessel, N. (1989). Genius and mental disorder: A history of ideas concerning their conjunction. In P. Murray (Ed.), Genius: The history of an idea (pp. 196 212). Oxford, England: Blackwell. Kraepelin, E. (1921). Manic-depressive insanity and paranoia. London: Churchill Livingstone.

INTERIOR LANDSCAPES OF MENTAL DISORDER Spoerri, E., Baumann, D., & Wo li, A. (2003). The art of Adolf Wo li: St. Adolf-giant-creation. Princeton, NJ: Princeton University Press. Styron, W. (1990). Darkness visible: A memoir of madness. New York: Random House. Sue, D., Sue, D., & Sue, S. (1986). Understanding abnormal behavior (2nd ed.). Boston: Houghton Mifin. Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15, 113118. Vassos, J. (1976). Contempo, phobia, and other graphic interpretations. New York: Dover. Wahl, O. F. (1992). Mass media images of mental illness: A review of the literature. Journal of Community Psychology, 20, 343352. Weisberg, R. W. (1994). Genius and madness? A

189

quasi-experimental test of the hypothesis that manicdepression increases creativity. Psychological Science, 5, 361367. Wiene, R. (Director). (1919). Das Kabinett des Doktor Caligari [The cabinet of Doctor Caligari] [Motion picture]. Germany: Decla Bioscop AG. Willerman, L., & Cohen, D. B. (1990). Psychopathology. New York: McGraw-Hill. Wilson, G. T., Nathan, P. E., OLeary, K. D., & Clark, L. A. (1996). Abnormal psychology: Integrating perspectives. Boston: Allyn & Bacon.

Received August 6, 2002 Revision received December 15, 2002 Accepted January 9, 2003