Dipping into Carl Jung on Schizophrenia

I have underlined the fact many times in these posts that human nature, or what is often called the human condition, is a complex one.  Such a general statement would also imply logically that the particular subset of humanity with psychological, neurotic, psychiatric, or psychotic ailments or difficulties is also, by definition, complex.  Indeed, it is more so, as it deviates so spectacularly from the norm in terms of perception of reality and behaviour.  I have also emphasised often the accepted opinion that the genesis of psychosis is multifactorial with a medically proven biochemical malfunction at base, but have also gone to pains to assert that there are many other compounding and exacerbating factors such as early experiences of dysfunctionality of family and social surroundings that include all forms of abuse, poor attachment to and early separation from the mother, and so on.  All these factors compound and exacerbate the psychosis.  Furthermore, in the treatment of psychosis, I have also emphasised the modern approach to the care of those with such a mental disability as being many-pronged: biochemical or psychopharmacological intervention at first, and then the application of various therapies such as psychotherapy in its many incarnations whether group therapy, music therapy, art therapy, writing therapy, dance therapy, drama therapy and so on. 

Here, I wish to discuss the contribution of Carl Gustave Jung to the understanding of schizophrenia through referencing two books, Memories, Dreams, Reflections (Fontana Paperbacks, 1983, hereafter designated MDR) and Jung: Selected Writings (Fontana Paperbacks, 1983, with an introduction by psychiatrist Anthony Storr, hereafter designated SW).  What interests me in Jung is the creative approach he took to treating patients who suffered from a psychosis.

Very early in his career as a consultant psychiatrist at the Burghölzli Psychiatric Hospital in Zurich, Jung observed all his patients carefully.  One day, he noticed an old female patient, many years in that institution, making all the actions particular to a shoemaker in the centre of the ward.  He was informed by the nursing staff that this lady was wont to make these actions several times a day.  In his memoir, he continues:

I then checked through her yellowing case history, and sure enough, there was a note to the effect that she was in the habit of making cobbler’s motions.  In the past, shoemakers used to hold the shoes between their knees and draw the threads through the leather with precisely such movements.  When the patient died shortly afterwards, her elder brother came to the funeral… and he told me that she had been in love with a shoemaker who, for some reason, had not wanted to marry her, and when he finally rejected her, she had “gone off.”  The shoemaker’s movements indicated an identification with her sweetheart which had lasted until her death.  That case gave me my first inkling of the psychic origins of dementia praecox (= Schizophrenia).  Henceforth, I devoted all my attention to the meaningful connections in psychosis. (MDR, p. 146)

 

Interesting, too, is the fact that he admitted that there were quite a number of psychotic patients for whom psychotherapy just didn’t work. Anthony Storr puts this succinctly: “Jung was never dogmatic as to a single cause of schizophrenia… He was also modest in his therapeutic claims, recognising that only a limited number of cases responded to analysis, and that partial alleviation was more common than cure…. Jung was also one of the first to recognise that a psychotic episode could be precipitated by analysis.” (SW p. 15) I also wish to refer to Joseph Campbell’s Myths to Live By, hereafter designated MTLB, in which there is quite a long chapter on mythology and schizophrenia.  Therefore, this review will cover active imagination, word association, personal and collective unconscious, symbols, archetypes and so on.  In general, then, what I am about here is the exploration of the healing power of the human imagination in helping us within a team approach, where this is applied with conventional medical intervention.  Again, a warning, while these imaginative approaches work very well, they are not a magic bullet or panacea to be used on their own in cases of severe psychosis. 

One of my favourite works of prose is Samuel Taylor Coleridge’s Biographia Literaria, wherein the famous Romantic poet and philosopher writes quite an extensive excursus on the imagination.  The truly educated man, he tells us in that work, is one who pursues the unity behind the many, seeking “to discover and express.... the connection of things.” In seeking such a connection between all things, the imagination is operative. In short, the creative imagination of the writer or composer fuses these disparate things together into a unity. In chapter ten, Coleridge describes the imagination as the ‘esemplastic’ power, a word he coined from the Greek, meaning ‘to fuse into one.’ (See Coleridge, S.T., Biographia Literaria, Everyman edition, ed. George Watson, 1975, p. 91 and 196). Again, psychotherapy in essence is a project or enterprise (essentially imaginative in its true sense) to fuse the disparate parts of the self into a whole. If one were to give a brief and too general a summary of Jung’s approach to analytical psychology, it would go something like this:  For Jung, mental illness is characterised by a disunity or fragmentation in the psyche or personality, whilst, on the other hand, mental health or wellbeing is characterised by unity. With this in mind, it is the task of the analyst to bring the unconscious aspects of the patient’s psyche to consciousness.   

Jung, following Pierre Janet (1859–1947), continued to write about the dissociation or splitting of the personality into subsidiary personalities, any of which could take over at different junctures.  However, his is not a multiplication of personalities but rather a splitting or dissociation of the personality, a definite fragmentation of the unity of the self into subpersonalities.

Moreover, Jung values greatly the centrality of story, another healthy and imaginative exploration for both the patient and therapist in the psychotherapeutic process.  The following is his account of the effectiveness of story and storying the self:

In many cases in psychiatry, the patient who comes to us has a story that is not told, and which, as a rule, no one knows of.  To my mind, therapy only really begins after the investigation of the wholly personal story.  It is the patient’s secret, the rock against which he is shattered.  If I knew his secret story, I have a key to the treatment.  The Doctor’s task is to find out how to gain that knowledge… Sometimes an association test can open the way; so can the interpretation of dreams or long and patient human contact with the individual.  In therapy, the problem is always the whole person, never the symptom alone.  We must ask questions that challenge the whole personality.” (MDR, p. 138)

Furthermore, the word association test, first introduced by the English polymath, Francis Galton in 1879, refined and developed into a clinical tool by Carl Gustave Jung in the early twentieth century, is yet another good example of the imaginative approach to assessing a patient’s mental state. While Galton aimed to study cognitive processes alone, Jung developed it to detect hidden emotional responses and "complexes", as he called them, that is, hidden psychological conflicts and other subconscious material. In this assessment, a list of one hundred words is read out, and the patient is asked to respond to each with the first word that comes to mind.  Jung timed the interval between the stimulus word and the response.  The subjects or patients, unknown to themselves, delay longer over certain words, and often it becomes clear that groups of words are linked around a theme which arouses emotions and concerns within the subjects.  Quite simply, the longer delays denote where certain complexes reside.   Indeed, it was Jung who first applied the word “complex” to such reactions, and it was he who first introduced the term into psychology. Anthony Storr puts it succinctly:

These experiments were important in that they described objectively, in ways which could be measured, the dynamic effects of unconscious mental contents.  They will also remind the reader that Jung was trained in the natural sciences and had an accurate grasp of scientific method, although his later interests drew him into fields where scientific method cannot easily be applied. (SW, p. 15)

Jung popularised his own technique called “active imagination” in an effort to allow the patients or clients or subjects to make their unconscious material conscious, and thereby help them in the process to integrate both on the road to a unity of self.  The pathway to that goal of unity of self, he designated “individuation.”  That, undoubtedly, as we all know too well, is the task of a lifetime.  In active imagination, then, the unconscious is accessed by intentionally engaging with dream images, any fantasies the client/subject/patient may have, or even moods in a waking state. Jung used this method to dialogue with inner figures or archetypes that crop up in the subject’s mind — such as the Shadow or Anima/Animus, the Puer Aeternus or Peter Pan Syndrome, the Senex or old man and so on — allowing them to speak and act autonomously, which helps to integrate unconscious material and foster individuation.  In short, Jung invited the patient to step into the dream or fantasy and dialogue with each figure therein, with the advice to let the characters lead and speak for themselves and never to try to control or censor the dialogue.  Furthermore, Jung encouraged creative expression in that encounter as is captured in the essential word “active”: to anchor the experience, he encouraged his patients to give form to their encounter with their unconscious through writing, painting, dancing, or drawing.

What is particularly noteworthy about the likes of Carl Jung and Ronald Laing is that they treated their patients like real persons with thinking, feeling and volitional attributes.  In short, they listened deeply to their patients as people not as collocations of symptoms.  However, as we have seen, Jung was way more balanced and circumspect than Laing, as he had reached the conclusion that therapy was of absolutely no use to some patients with serious or deep psychosis. I have already stressed above that Jung realised from his experience at the Burghölzli Psychiatric Hospital in Zurich from 1900 to 1909 that only a limited number of cases responded to analysis, and that partial alleviation was more common than cure. 

“Psychogenesis” was another word that Jung often used with respect to certain cases of schizophrenia, and these were cases with whom he could properly work or analyse.  This term refers to the origin and development of mental functions, traits, or conscious/unconscious behaviours, often describing how psychological factors produce mental or physical symptoms. It highlights that some illnesses or behaviours originate from emotional, mental, or symbolic causes rather than solely organic ones.  While I can find no reference to the fact that Jung would have seen those cases that could not be analysed as cases where the aetiology was organic or endogenous, that is, rooted in the physiology or even biochemistry of the brain, he does admit that “the psychogenesis of schizophrenia would explain why certain milder cases, which do not get as far as the mental hospital…. can be cured by psychotherapeutic means” (SW, p. 43) However, writing in 1957 he was very pessimistic about the cure of serious cases of schizophrenia: “With regard to the possibility of a cure, however, one should not be too optimistic…. The very nature of the disease, involving as it does the disintegration of the personality, rules out the possibility of psychic influence, which is the essential agent in therapy.” (SW, p. 43) Thankfully modern medicine now offers a more positive prognosis and often improves the lot of many sufferers through psychopharmacological intervention as well as psychotherapy in all its incarnations.

This leads me nicely to the final few paragraphs of this review by way of referring in some detail to a chapter on mythology and schizophrenia from the pen of Joseph Campbell, the great mythologist.  The actual title of the chapter is “Schizophrenia – the Inward Journey.” (MTLB, p. 201 – 232).  As a reader with an interest in literature, mythology and mental health, I was at first taken aback by the length of the chapter, some 32 pages.  How any scholar could manage 32 pages on the relationship between mythology and schizophrenia simply amazed me on first and even second reading.  I found this chapter to be highly esoteric as the author gives us accounts of native Indian customs, ancient shamanic practices and rites as well as in-depth reflections on mythology, and unless the reader is acquainted with such esoteric subjects, one could easily feel lost in a thick forest of intricate detail.  Thankfully, on the second page, Campbell gives us a nutshell summary of his main approach: “The imagery of schizophrenic fantasy perfectly matches that of the mythological hero journey, which I had outlined and elucidated in 1949, in The Hero with a Thousand Faces” (MTLB. p. 202).   The journey of both the mythological hero and that of the schizophrenic apparently shares a similar and universal pattern.  Another way of putting it would be to say that the journeys of both correlate.  For Campbell, that pattern or algorithm is i) separation from home/family, ii) initiation into an awe-inspiring and frightening mystery and iii) return. The mythologist avers that “the hero comes back from this mysterious adventure with the power to bestow boons on his fellow man.”   As a psychotherapist and a person who knows several people with this “harrowing disorder” as Professor Clare puts it, I find this correlation with schizophrenia extremely fanciful, threadbare and undervaluing of the suffering of the patient.  Yet, I can see a little correlation for a person who, in hindsight, after many years of psychiatric and psychotherapeutic care, has managed some personal growth in individuating.

Campbell does share with us an insight into Jung, who, he says, expresses best the potent images or symbols, called archetypes, that occur in all myths, no matter what culture.  Human beings are governed by their “inherited biology” (nature) as well as by their “personal biography” (nurture).  “Archetypes of the unconscious” are expressions of the first of these categories.  The author further states that “in a schizophrenic plunge one descends to the ‘collective,’ and the imagery there experienced is largely of the order of the archetypes of myth.” (MTLB, p 210) Several of Campbell’s stories about shamanism, mysticism and experiences with LSD (It’s not obvious from the text if this is his own personal experience or the reported experience of another) are at least fanciful and unreal, or at most genuine and mystical. Here is one of Campbell’s insights into schizophrenia, and I’ll let you decide whether this is outrageously unreal or authentically mystical: “In the course of a schizophrenic’s retreat into himself, the psychotic too may come to know the exaltation of a union with the universe, transcending personal bounds: the “oceanic feeling,” Freud called it… things that before had been mysterious are now fully understood.  Ineffable realizations are experienced; and in fact as we read about them, we can only be amazed.” (p. 219)

Overall, I found this chapter to be partaking of the fallacy of Gish Gallop. Gish Gallop is a fallacious debate tactic that involves overwhelming an opponent or, in this case, the reader, with a rapid barrage of numerous, often weak, and very often confusing arguments, making it impossible to refute them. Coined by Eugenie Scott to describe creationist Duane Gish's techniques, it aims to win through sheer volume rather than accuracy. Hence, I was initially left confused and began doubting my powers of comprehension.  I often suffer from imposter syndrome anyway, and sometimes even the fear that I am losing my memory as well as my ability to judge what’s true or false.  However, let that aside remain as it does express one of my present existential fears as I age.  Let me return to my topic immediately and recount a summary here that Campbell leaves us with:

The inward journeys of the mythological hero, the shaman, the mystic, and the schizophrenic are in principle the same; and when the return or the remission occurs, it is experienced as a rebirth; the birth, that is to say, of a “twice-born” ego no longer bound in by its daylight-world horizon.  It is now known to be but the reflex of the larger self, its proper function being to carry the energies of an archetypal instinct system into fruitful play in a contemporary space-time daylight situation.  One is now no longer afraid of nature, nor of nature’s child, society…. The new ego is in accord with all this, in harmony, at peace; and, as those who have returned from the journey tell, life is then richer, stronger, and more joyous. (p. 230)

Make of that what you will, but such an intellectualised approach to schizophrenia is quite meaningless on its own, and hardly empathetic to the feelings of either those who suffer with such a harrowing burden or of their close family who must endure the often long, painful fallout of this mental disorder.  However, I have to remind myself that Joseph Campbell is a wonderful scholar in the field of comparative literature, classics and mythology and is in no way an expert on mental disorders, and, in fairness, he does stress this latter point at the beginning.  It is also very clear to this reader that Campbell simply knew no one with the actual complaint.

The above finally finishes my review of works dealing with schizophrenia.  They have served as my way of making sense of the lives of people I know who suffer from this harrowing disorder and my interaction with them.  It is surely time to review literature of a lighter vein, and put an end to this ongoing preoccupation.  Many thanks to my readers for staying with these extended reviews on one rather deep and often disturbing subject.