ORIGINAL ARTICLE Creativity, self creation, and the treatment of mental illness A Rothenberg ............................................................................................................................... J Med Ethics; Medical Humanities 2006;32:14–19. doi: 10.1136/jmh.2004.000185 This paper examines how an understanding of systematic findings about creative processes involved in art, literature, and science can be applied to the effective treatment of mental illness. These findings and applications are illustrated by particular reference to the work of the poet Sylvia Plath and the treatment of a patient who aspired to become a writer. ........................................................................... ....................... Correspondence to: Professor Albert Rothenberg, MD, Harvard University, Box 1001, Canaan, NY 12029, USA; albert_rothenberg@ hms.harvard.edu Accepted for publication 14 December 2004 ....................... H ow can an understanding of the kinds of creative thinking involved in art, literature, or science apply to our treatment of mental illness? Not just the performance of any specific therapy, but medical management of mental and emotional illness? The answers to this question will take me into the nature of mental illness impairments, the definition of creativity and creations, and also into the dark pathways of destructiveness in relation to creativity in art and life. To illustrate these matters, I shall conduct a critical and hopefully meaningful investigation of the final poetry of the star crossed Sylvia Plath, and relate the story of the treatment of a self destructive mental patient who strove mightily to be a creative writer. Most salient of all, I shall consider the difference between, on the one hand, the control and suppression of feelings, and on the other the unearthing with self knowledge that is intrinsic to the creative process. I shall not—it has become important nowadays to say—propose that mental illness produces artistic creativity, a rather popular current notion for which there is no scientific basis at all. 1–3 First, however, to present an approach to all these matters, I shall adopt a broad perspective on the nature of pathology in both psychiatric and general medical illness. NORMALITY, CREATION, AND TREATMENT Let us look at the fundamental issue of normal- ity, a fairly straightforward physiological matter but more complicated for psychiatry. When a patient has pneumonia with cough, sputum, and fever, the patient and his or her organs are not functioning normally. To be normal, they must get back to their prepneumonia state. When the deficiency is corrected, patients will be ‘‘like everyone else’’, their lungs functioning healthily, just like the average—or just like the vast majority of people of their age. With the treatment of mental and emotional illness, however, the notion of the average or the majority as normal (even in equality loving and democratic cultures) is acceptable neither to patients nor practitioners. Mental health is not considered equivalent to being average or to being the same as everyone else. Moreover, returning to average functioning or to a previous state may not suffice for ameliorating the illness. Once one develops a mental illness, almost invariably there are continuing problems. In a lesser way, this also applies to pneumonia. After having the infection and being effectively trea- ted, the patient is never exactly the same as before. The diseased lung area is permanently scarred. Although minuscule, the residual scar remains for life. Lung scarring is a deficiency but the pneumo- nia will not by and large recur unless there is exposure to the infectious organism, this can, with reasonable precaution, usually be pre- vented. With mental and emotional illness, on the other hand, the recurrence threat is greater because human beings up to the present time have never been able to prevent exposure to the social and environmental stresses and threats of everyday life. In attempting to help a patient return to functioning or coping or adapting, more is needed than can be accomplished with medication alone. With the scar of mental illness, patients need to be able to adapt better to their environments than others who have not been scarred at all. Even if practitioners do not see things this way, patients inevitably do. Although it is difficult therapeutically to define what it means to adopt the goal of helping any given individual patient ‘‘to function,’’ that patient most often has already rejected such a goal or the term itself out of hand. Nor do patients accept the aims of ‘‘coping’’ or ‘‘adjusting’’ or even ‘‘adapting’’ very readily. They want to be better than they were, better than others, and thereby better able to deal with the constantly problematic circum- stances in which human beings live, at that time or in the future. Both patients and therapists are oriented to, and engaged in, facilitating creation. Both are focused on the patient’s creation of his or her self or aspects of self—an ongoing process of self creation. 4 By self creation, I mean something directly analogous to creation in the arts and sciences. In these fields, creation is most meaningfully defined as the production of something both new and valuable. 5 In the process of achieving self creation through systematic case manage- ment, adjunctive or intensive psychotherapy, something new and valuable is also produced. Patients make themselves, or aspects of them- selves, better than before. They break away from the past and produce features that are new. Medications provide reduction of symptoms and conjoint psychotherapeutic approaches should be intrinsically processes of facilitating self creation 14 www.medicalhumanities.com group.bmj.com on January 24, 2016 - Published by http://mh.bmj.com/ Downloaded from