Literature as an exploration of the phenomenology of schizophrenia: disorder and recovery in Denis Johnson’s Jesus’ Son Jay A Hamm, 1 Bethany L Leonhardt, 2 Rebecca L Fogley, 2 Paul H Lysaker 3,4 1 Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, Indiana, USA 2 School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA 3 Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA 4 Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA Correspondence to Dr Jay A Hamm, Wishard Health Services, Midtown Community Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202, USA; jay.a.hamm@gmail.com Accepted 6 February 2014 To cite: Hamm JA, Leonhardt BL, Fogley RL, et al. Med Humanit Published Online First: [ please include Day Month Year] doi:10.1136/medhum- 2013-010464 ABSTRACT When read as a fictional psychosis narrative, Jesus’ Son, a collection of short stories by Denis Johnson, reveals important elements of the phenomenology of schizophrenia and recovery. It is possible that Jesus’ Son, as a work of fiction, may be able to uniquely add depth and nuance to an understanding of the phenomenology of schizophrenia involving a state of psychological fragmentation, an ever-changing interpersonal field and a loss of personal agency. In addition, by following the protagonist in Jesus’ Son as he begins to resolve some of his difficulties, the book also offers an individualised account of recovery. The authors detail how the book reveals these insights about schizophrenia and recovery and suggest that these elements are intertwined in such a manner that leads to a profound disruption of self- experience, characterised by a collapse of metacognitive processes. Jesus’ Son may add depth to our understanding of the subjective experience of schizophrenia and recovery, and also may serve as one example in which the study of humanities offers an opportunity to explore the human elements in the most profound forms of suffering. INTRODUCTION The role of narratives, including fictional and non- fictional narratives, in the study of illness has received increased attention across a number of dis- ciplines in recent years. 1 In mental illness, the reading of fictional narratives has been suggested for a range of purposes, including increased under- standing of psychopathology, enhanced empathy and the development of skills in ethical reflection. 23 Fiction, as well as other forms of creative art, has also been used to enhance an understanding of the experience of the most severe forms of psychiatric disorders. 45 Jesus’ Son is a collection of short stories by American writer Denis Johnson. 6 Although mani- festly a tale of drug addiction, the book can also be read as an account of psychosis and recovery. Understood in this manner, Jesus’ Son offers the reader insight into schizophrenia and recovery by providing a window into the phenomenology of prolonged psychosis. In this paper we will detail how Jesus’ Son adds depth to our understanding of the phenomenology of schizophrenia and also offers insight into what recovery from schizophre- nia might look like. Although it is possible to glean from the text evi- dence of the symptoms that serve as the formal diagnostic criteria for schizophrenia, the intention here is not to read Jesus’ Son as a fictional diagnostic case study. Rather, the value of Jesus’ Son as a fictional schizophrenia narrative appears to be in its ability to enhance a phenomenological understanding of core processes at play in schizo- phrenia. As a fictional account, Jesus’ Son may avoid certain identified dangers inherent in the study of biographical or autobiographical narra- tives, including concerns about establishing the ‘truth-value’ of the account, 7 while still offering a rich, nuanced first-person view into schizophrenia that is not accessible through quantitative research. This is consistent with suggestions that the use of fiction might uniquely offer insights into schizo- phrenia that might not be available through trad- itional avenues of study. 8 This manner of analysis may be one strategy for exploring and understand- ing the humanity within schizophrenia and is thus consistent with the broader aims of the medical humanities, such as the development of an ethic which emphasises the importance of subjectivity and self-experience within medical conditions and the promotion of reflective and humane medical care. 9 10 The importance of these aims may be further underscored when applied to the most pro- found forms of suffering. 3 11 To address this possibility, following a brief synop- sis of the book, we will explore a number of inter- related phenomena revealed in Jesus’ Son. More spe- cifically, we will describe three elements found in the book that offer the reader a deeper understanding of the phenomenology of schizophrenia. These ele- ments include a view of a subjective state charac- terised by pronounced fragmentation, a state in which the subjective interpersonal field is amorphous and bereft of stable others and a state in which a person no longer possesses agency. We will then offer a conceptualisation of a profound disruption of self- experience stemming from these intertwined ele- ments. After this, we will discuss how these difficul- ties appear to begin to be resolved as the book’s protagonist progresses toward a state of increased organisation and improved functioning, illustrating a view of recovery as more than a matter of symptom relief and or dissipation of pain. Finally, we will con- sider how these insights align with current research interested in the experiences of people with schizo- phrenia and offer implications for clinical practice. A BRIEF SYNOPSIS OF JESUS’ SON Jesus’ Son is written as a collection of short stories, although the stories are linked thematically and through ostensible continuity of a single unnamed narrator-protagonist. Taken as a single work, Jesus’ Son offers a fragmented narrative of a troubled Hamm JA, et al. Med Humanit 2014;0:1–6. doi:10.1136/medhum-2013-010464 1 Original article JMH Online First, published on February 24, 2014 as 10.1136/medhum-2013-010464 Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on February 25, 2014 - Published by mh.bmj.com Downloaded from