The act of a form is that by which a form forms itself:
It is its autogenesis 1
This article is a collaboration between Helene Cæcilie Mørck, an expert by experience and professional choreographer, and Giovanni Stanghellini, a psychiatrist trained in phenomenology. Expert by experience in this context refers to someone with firsthand knowledge of mental illness. It is a co-written paper which means it is based on sharing perspectives and meanings about the experience of crisis, recovery, and the healing process. Cowriting can be defined as the practice in which clinicians or researchers and individuals with the lived experience of a disorder are mutually engaged in writing jointly a narrative related to the given condition. It represents an innovative approach that may foster new advances in psychopathology research. Collaborative writing must honor the challenge of maintaining each subject’s diction and narrative style without capturing or formatting them in pre-established narrative models 2,3.
This paper initially emerged from a conversation about taking a stance against schizophrenia that followed the exchange of articles published or edited separately by the two authors of this paper 4-12. This led to the question about strategies for dealing with schizophrenia and to the question of which types of position-taking are effective in this respect, particularly the one developed by Helene Cæcilie, i.e., dance. By “position-taking” (Stellungsnahme), following Husserl 13, we mean a class of intentional acts which entail an active and, to a certain degree, free orientation toward a given experience 14,15. Position-taking includes theoretical stances (such as illness awareness, or constructing a narrative of one’s illness, or developing an explanation of one’s own uncanny experiences by structuring a delusion, etc.) as well as practical comportments (such as in goal-directed and motivated actions 16 like the creation of artistic handicrafts or dance itself). For Helene Cæcilie, dance has served as an artistic outlet for schizophrenia, allowing her to work and exist in the world.
Journal of the formless
Helene Cæcilie began keeping a diary when she was seven because she had so many thoughts. She believed she would vanish if she did not write. She was quiet most of her childhood and youth. The act of writing was a release from speaking. Speaking and interacting with people was a struggle, and writing felt like a calm place where her mind and voice could be heard silently. Writing also numbed the overwhelming feeling of disappearing.
Schizophrenia eventually manifested in her early twenties. The initial years were chaotic. She was frequently hospitalized in psychiatric wards due to her numerous acute psychotic episodes. Throughout this time, her journal never left her. During episodes of acute psychosis, she often suffered from blackouts and memory loss. It might be seconds, hours, or weeks long – nevertheless, she continued to write. The writing was not a deliberate act: having written daily for her entire life, it had become a habit or a sort of automatism. In psychosis, her right hand had a life of its own and wrote automatically. Something unconscious emerged from the depths. She had no idea what she had written or recollection of ever doing it; she only knew she was writing because of numbing pain in her arm. The tightness of her grip manifested itself through her arm.
For her, psychosis has always been two different states simultaneously: “sinking and “sharp light”. The dark and bright sides of psychosis coexisted in Helene Cæcilie’s experience. The former was a sense of total chaos, where language, the sense of self, and body seemed to go everywhere in space and time. An agonizing feeling of dismemberment, pulverization, dissolution: “emptiness”, “exist[ing] in the wind”, “flesh powder”, “flutter[ing] in the wind like laundry hung to dry”. At the same time, she felt a profound joy, immensity, and burst of creativity. It felt like she was connected to all the energy in the universe. It ran through her with a force that was supernaturalistic-fantastic-over-earthy, pure energy, an untamed desire. Psychosis has always been an extremely positive force for her when it was full-blown. She has never been only afraid of chaos but also embraced it. In the following paragraph, we provide as an example an extract from Helene Cæcilie’s journal.
Extract from my journal
Tonight, and always, I feel uneasy and insecure. I don’t know where I have myself; there is so much turmoil in life, oil, and feathers, oil, and feathers. Forgotten tears- body emptiness and that emptiness I hate – the longing for it – I can drift away and forget. I exist and forget the pelican in the wind. I hate it – scarecrows prevent me from speculation – enjoying life, or remotely enjoying. Everything vibrates and screams, and I feel no heartbeat. The air is humid, and I feel slightly clammy – dewy moisture – berating air, or I don’t know what to call it: Russian mite-mittens acid and infection-free trials. Everything is up in the air. Infested parasites, hot half-dead breath, stupid inferior frogs. All doubts and prejudices hang in the air like dead rats and plague-infested mites. The world has died, and I don’t know my selfness hang.
My whole being is apathy. Soul and its emptiness confabulate the universe; it flutters in the wind like laundry hung to dry. I hold on to my nails. All fall, the sky, the clouds, and, not least, self-esteem and self-confidence, and human flesh powder. I wait for the curtain to hit me in the head. Mortar and concrete do not touch me, and windows visions of the dead. God surrendered – angels screamed in distress, sharp teeth shattering – eardrums broke. People held their ears. God is dead. Angels are crying out, impotence, solutions, I need solutions. I need solutions. Where is my soul? It has forgotten me; my feet have evaporated themselves. I am sinking-sharp light.
Deciphering and deconstructing
When the psychosis diminished, and she reconnected with reality, Helene Cæcilie was confused and scared. This exhilarating and, at the same time, terrifying experience – her body expanded to coincide with the entire universe and, at the same time, evaporated to the extreme point of no longer existing – that characterized the acute phase of psychosis suddenly disappeared. The disconcerting experience that saw the dark and the bright side of psychosis united suddenly shattered. What remained was feeling like just a “scattered” body.
The negative part of psychosis was not when she was in it but when she came out of it. The post-psychotic period was a kind of “psychosis-hangover” – deflation following an inflation experience. When reality crept in, apathy overwhelmed her as the energy of the universe left her:
I deflate, and the real world hits me; everything feels raw and shakes. I am overwhelmed, then the feeling of falling apart and being boneless is overwhelming. It becomes incredibly painful, I can’t feel anything, and I just want to kill myself or return to my beautiful psychosis (but it is impossible), so I am left in this horror of reality.
Even worse than this was that she could not remember what had happened because psychosis was such a chaotic and disorganized condition to her. Acute psychosis did not allow a cognitive reconstruction, a logical and orderly narrative of what had happened. It was painful not to remember what had occurred. She turned to her journal for consolation and observed crooked handwriting that did not resemble her own. She tried to read the scraps of information she had jotted down on paper. She saw patterns and lines of information; it was like trying to decipher a notation system she did not know. Slowly, she began to understand the handwriting and content. She started rereading her journal. There were racing thoughts and strange connections she needed to understand. She tried to deconstruct the sentences and then reconstruct meaning where there was no meaning at face value. It steadily but slowly started to make sense. She knew that she needed to express the inexpressible. She wanted to make sense of the unsensible. She had to give the formless a form, making the chaotic experience real. When she was discharged from the hospital, she returned to her work as a dancer and choreographer.
Giving form to the formless
Helene Cæcilie’s Journal of the Formless had to become a choreography. Since she did not succeed in connecting the dots and expressing her emotions, sensations, and ideas in ordinary language, she tried to do this through her body – the only expressive instrument she really mastered. She started to arrange words from her journal into movement qualities and give them form through choreography. Even if it was not a true synthesis, it was at least an attempt at reconstruction. The dance studio felt like a canvas where she could inscribe movements in space and time. Dancing, she wanted to capture the feeling of being in a different reality. She wanted to embody what she had felt in acute psychosis. The rhythm, breath, and sensibility of the body. How could she give it a form? What music should she use, and in which format should it be expressed? There was so much that needed to get out of her body.
As she moved and was moved by the movement, the blackout and memory loss she had experienced during the psychosis seemed to evaporate. She remembered the unspeakable first as a flow of illusive subjective sensations, but then it became concrete as she canalized it through her body and movement. Her mind could not recollect the tension, shock, and rhythm of it all – but her muscles could remember the sound and sterility of the hospital and how that had affected her vulnerable body. Her fragmented and disembodied Self started to fall into itself and find its place. Her shaking body seemed to rearrange and calm down. As the movement took shape and found its purpose and her subjective reality was projected into space, she felt she was becoming more formed. The formless took form. She could express herself and just be. The music flowed through her, and she felt that the essence and substance of who she was during her psychotic episode manifested in space and time. As the choreography developed and found its structure, so did she return to herself.
After being discharged from the hospital, I felt so isolated and fragmented, like my bones were scattered, but getting back to dance and choreography saved me. I could use my dance to express and make choreography from traumatic experiences. By dancing with schizophrenia, I could turn it into something life-affirming and give it form and expression.
Choreography as a memory map
Choreographies have always been, to Helene Cæcilie, a memory map of her world of subjective experiences. She can track the titles of her choreographies twenty years back and, through the dancing, pinpoint her mental state at that time. In this paragraph, we provide two exemplary choreographies expressing Helene Cæcilie’s experience of psychosis.
Helene Cæcilie was confined to her apartment because she was depressed and feared going out, people scared her, and her body felt weird and deformed. During this time, moths invaded her apartment. Food and clothes were infected. It drove her crazy. She ran obsessionally around trying to kill the moths. One day she stopped running and started dancing; instead, it was a revelation. Her feelings of loneliness and anxiety manifested in space. She was the moth, this little grey creature flapping around the room. It was a transformative moment and gave her the courage to step out into the world again after months of isolation. Later she performed the choreography at a solo festival.
Some years later, she became aware of the emblematic meaning of the moth. The moth is an animal that corrodes and is destructively attracted to a flame. It is associated with passion, night, waste, and finally17. The moth is the personification of a poetics of the formless18: living life as close as possible to the borders of death, not preserving one’s existence but spending it to the point of total waste, an ephemeral flapping of wings that is consumed without insurance, disordered and unpredictable, before becoming centripetal and falling prey to the fascination of fire – that is, returning to itself, reuniting with the element of which the passion it embodies is made 19. It is known that the fate of the moth is to burn by falling into the fire it was attracted to and around which it danced and flew all night.
Boneless and Incomplete
Before she created this work, Helene Cæcilie had just been hospitalized for a more extended period. After being discharged, her body felt raw and defragmented, like her bones were scattered. She felt so incomplete and isolated. She was afraid that her body would evaporate. She realized that she needed to dance and get everything out. In her head, she only had the title Boneless & Incomplete, but then the work emerged and became a work for thirteen dancers. The choreography came from a very bleak place, but when she transformed this bleak place onto the stage, it metamorphosed into something completely different and life-affirming.
Reading a book on the experiential dimension of schizophrenia, the title she had given to her choreography resonated with a sentence spoken by a person with schizophrenia “I lack the backbone of the rules of social life” 20. In this patient, the experience of being disembodied, which is not rooted in his own body, distant from his own emotions and bodily feelings, and experiencing his own body as a sort of impersonal mechanism, was combined with suffering from social isolation, the inability to attune with other people, to understand their behavior and communicate with them. Being boneless is tantamount to not being rooted in one’s own body and, at the same time, lacking a solid foothold to connect and get in touch with others and with the things that populate the real world.
Gestaltung as a way to heal disintegration in schizophrenia
Helene Cæcilie’s experience shows the dialectic of disintegration and reintegration that characterizes the existence of a schizophrenic person. In her existence, this dialectic consists in transforming a “very bleak place” into something “life-affirming” through choreography. Attempts at self-healing have been described in the life-history of many persons with schizophrenia 21. These include, for instance, shutting down as a response to social hypersensitivity, detachment from one’s body to defend oneself from the anguish produced by feeling overwhelmed by distressing bodily feelings, delusional explanation of uncanny Self- and world-experiences, but also the creation of art products, and, finally, in Helene Cæcilie ‘s case, self-healing through dance. Delusional explanations, creation of art products, and dance can be traced back to a process of Gestaltung – a German term that in English can be rendered as “form in formation” – the act of giving form to the experience of the formless. It is not easy to provide an operational definition of the formless. However, the experiences described by Helene Cæcilie in her diary and in her choreographies can help us: being boneless and turned into a moth eloquently express the feeling of insubstantiality, precariousness, incompleteness, dissolution, loss of integrity, itemization, and powerlessness, which – combined with its being almost inexpressible in ordinary language – make this experience almost ineffable. Disintegration of Self- and world-experience is just the other side of the coin of disintegration of ordinary language and commonsense cognition.
We find Gestaltung at work in the chiasm linking the moment of disintegration and that of reintegration in the course of schizophrenic existence.
We will briefly analyze delusion formation and artistic creativity as forms of self-healing before concluding with some thoughts on the relationship between dance, Gestaltung, and schizophrenia.
Perturbation of the sense of Self is considered a core experience of disintegration in persons with schizophrenia. We have several outstanding reports of experiences of disintegration of Self 22-26 space 27 and time in schizophrenia 28. We will confine our description to this eloquent autobiographic testimony by philosopher and expert by experience Elyn Saks:
Consciousness gradually loses its coherence. One’s center gives away. The center cannot hold. The “me” becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal. There is no longer a sturdy vantage point from which to look out, take things in, assess what’s happening. No core holds things together, providing the lens through which to see the world, to make judgments and comprehend risk. Random moments of time follow one another. Sights, sounds, thoughts, and feelings don’t go together. No organizing principle takes successive moments in time and puts them together in a coherent way from which sense can be made (…) My awareness (of myself, of him, of the room, of the physical reality around and beyond us) instantly grows fuzzy. Or wobbly. I think I am dissolving. I feel –my mind feels- like a sand castle with all the sand sliding away in the receding surf (p. 12-13) 29.
Sometimes, the schizophrenic person’s response to this experience of disintegration is a kind of withdrawal from the world:
I grew somewhat quiet and withdrawn – “in myself”, as I came to call it, when it had become much more extreme. Unless spoken to, I didn’t have much to say; I wasn’t sure I even deserved to be heard. I’d started to believe (or, perhaps more correctly, feel), that speaking was actually “bad”. Perhaps this was the beginning of my estrangement from the world, the very first inkling of my illness, something I’d never really experienced before, and a habit of mind that would intermittently mark me for the rest of my life 29.
Yet, on other occasions, disintegration – oneself and the surrounding world itemized into a series of unrelated details – may turn into its opposite: all details hang together and point to an experience of sudden revelation. The “cloud” of the fragmented details suddenly hangs together, and the hidden meaning that hides within all objects comes to a manifestation. This is a way to the genesis of schizophrenic delusions: the fragmentary intimations that twinkle in the experience of itemization can shape up into a full-blown revelation experience 30.
Whereas current approaches to the investigation of delusions have implicitly adopted a delusion-as-dysfunction paradigm (when someone has a delusion, it is because something in that person’s mind/brain cannot perform its correct function or goal), clinical phenomenology has adopted the delusion-as-strategy paradigm – delusions have a purpose or function, for the person and may be understood, in some circumstances, as potentially adaptive 31. Especially in systematized delusions in schizophrenia, epistemic and psychological benefits have been highlighted in the form of an increased sense of coherence and enhanced sense of meaning in life 31.
Artistic creation as a form of Gestaltung
Disintegration, in its various forms, is a fundamental feature of schizophrenia. Persons may experience their selves as being divided or otherwise compartmentalized into semi-independent parts or not existing as one unified whole 32; they may have feelings of body fragmentation, i.e., the shifting around of parts of the body, or a dynamic distortion of body Gestalt, i.e., of one’s body as a unitary and integrated structure 33. Patients may also experience their environment as fragmented, as a mere collection of unrelated items and decontextualized details standing out, losing all connection with the context background 34. It has been argued that all the schizophrenic person’s efforts are directed at compensating for this disintegration - putting together, reassembling what is scattered. Patients are described who use to collect whatever they can find and with them and make bizarre objects using these 35. According to the psychiatrist and art historian Hans Prinzhorn (who significantly contributed to our understanding of the borderline between psychiatry and art, mental illness, and artistic self-expression), reassembling is a fundamental drive which, together with the drive to decorate, to order, to imitate, to symbolize, to play and finally to shape, underlie schizophrenic art 36. If previously the artistic works of the mentally ill were undervalued, with Prinzhorn, this type of artistic production is of considerable importance, limiting any judgment of aesthetic value.
Fundamental to Prinzhorn’s thought is the concept of Gestaltung, which can be interpreted both as a supra-individual core of the artist and as a psychic need to plastically compose fragments of reality. What Prinzhorn identifies in schizophrenic production and indirectly in expressionist works, are unbridled playfulness, ornamental monumentality, figurative fragmentariness, and religious or erotic themes.
French psychiatrist and art expert Jean Oury proposes a neologism – enformé – to name the need to compose something that is not necessarily a completed form but the very action of forming, that is, of collecting and putting together. The difference between forme and enforme, and between Gestalt and Gestaltung, is the difference between the thematized form in structure and the form in the act. Schizophrenic persons, in this view, are therefore seen as “bricoleurs” since it is deemed essential to them this creative process of bringing together what is dispersed in the world, which is, at the same time, a process of reconstruction of one’s own Self – since in schizophrenia world-disintegration reflects Self-disintegration.
Why dance was therapeutic to Helene Cæcilie
The question is, “How could dance help Helene Cæcilie to heal the disintegration of her Self and world and give a form to herself?”.
Maxine Sheets-Johnston – a dancer who in her life studied the phenomenology of movement 37 – suggests that the dancer experiences the dance as a constantly moving form that is unified in its progression through time 38. The dance is not a series of disconnected moments but rather a continuous flow that is constantly in the process of becoming. The dance is experienced as “ekstatic”, as if the dancer is continuously in the process of transcending herself. For the dancer, dance is a unique temporal phenomenon that is constantly in the process of becoming, never fully realized in any single moment.
In dance, the human body transforms and is experienced as transforming its own material reality. A dance, as it is formed and performed, is experienced by the dancer as a perpetually moving form. A dancer is pre-reflectively aware of herself as she creates the dance. The force of movement conveys the feeling of a body spatially unified and temporally continuous. Dance creates a unity of succession – i.e., a pre-reflective, embodied synthesis of the single movements that occur in dance performance. So long as the dancer is one with the dance, she is a spatial and temporal totality, a unified and continuous creation existing across a multiplicity of instants and points. The dancer exists as a trajectory exists, that is, not at any single instant or point but in the whole of the phenomenon that the moving force creates. While dancing, the dancer exists her body in movement as a form continuously projecting itself toward a spatial-temporal future. It’s only on the pre-reflective level, when the dancer exists her body in movement as a form-in-the-making, that the dancer feels herself spatially unified and temporally continuous.
With all this in place, we can try to understand the nexus between dance and healing in Helene Cæcilie’s existence. Dance was her way of reintegrating what psychosis had disintegrated. When Helene Cæcilie started choreographing, her life changed. Dancing allowed her to feel her body as a unitary entity integrated with her Self and situated in the world.
I see myself in the mirror, the different parts are out of sync, but as soon as the exercise and music start, I feel my body collect itself and fall into place.
It felt like her body had been joined, and she regained control over the uncontrollable. She could express her emotions, such as anger, fear, happiness, and sadness. A sudden force took place, and movement flowed. Dance gave the world its purpose. It was empowering, and she felt strong and even invulnerable. She used choreography to channel the raw material which popped up disjointed in her subconscious mind. She could better manage her mental and physical distress when communicating with the body. She found an outlet and transformed her anxious, nightmare-filled world into characters and stories.
The world compass has turned around. I dance in a drop of water. Time is compact; ghosts disappear, and my body is pure electricity.
Rearranging material through improvisation enabled control of her body and the possibility of shaping it in the direction she wanted.
I am leading from the elbow, making a circular pattern in space-drawing meaning from the movement itself.
As a result of this new sense of agency, her perception of the surrounding world changed. In unison with this positive metamorphosis of her body, even the naked dance studio transformed into a living scenario, and she could control space and time. She also felt that the heat from her body was able to create a filter between herself and the world, and a feeling of safety emerged. Also, while dancing, she could merge into a character that would channel emotions and expressions—someone with a stage presence:
Stories are morphed into my shins and stomach; the force awakens and shoots out into space. I am Vilvira the powerful.
It was as if the choreographer in her were this strong creature with individual autonomy. Her body became a conductor to myriad impressions that reverberated within her and imprinted her soul with a previously unknown force.
Last but not least, she had a profound attunement with the other dancers on stage. She felt like taking on the world. Thanks to dance, both the feeling of being a Self and that of being together with others and at the right distance from them emerged.
In Helene Cæcilie’s life, the power of dance created an indivisible and cohesive whole where before, there was a dispersed Self and a fragmented body:
The presentness of the room, my breath, counting, the flow of energy, and… me.
Since there was no longer a dispersion of parts but a spatial totality, Helene Cæcilie experienced her body as existentially unified in space. Since she did not feel any more temporally dispersed, she experienced her body as existential continuous in time. Yet, once the dance ceases to exist, her body in movement as a form-in-the-making, and instead, the dancer apprehends it as an object, these feelings of continuity and cohesion may die.
Conclusions and directions: dance as embodied temporal synthesis and as a form of treatment for psychotic disintegration
It is well known that disturbance of the immediate awareness of self-unity, of the continuity of the Self, of the boundaries of the Self, and of awareness of Self-activity are core features in the process of disintegration that affects people with schizophrenia.
Temporal fragmentation has been considered as a generative disturbance of each of these dimensions of schizophrenia 39: with the fracturing of the time flow, we observe an itemization of “now-moments” in consciousness so that each “now-moment” in a person’s stream of consciousness will be experienced as detached from the previous one and from the following, hence as extraneous to one’s stream of consciousness, sense of selfhood and agency.
In schizophrenia, the collapse of the very vector-like nature of the present moment occurs 40; as a result, life itself can turn into a series of stills. Also, major schizophrenic symptoms (e.g., thought insertion, hallucinations, or passivity experiences) have been regarded as manifesting a disturbance of the constitutive synthesis of time consciousness 41.
In Helene Cæcilie’s history, each of these core disturbances was, at least in part, healed by dance.
Helene Cæcilie’s experience of herself and of the world, especially during acute psychotic decompositions, was characterized by disintegration – a lack of integration between different snapshots of experience. Phenomenologists interpret this fragmentation of experience as the outcome of the breakdown of temporality. Husserl calls “passive synthesis” the implicit function that operates the synthesis of the individual fragments of experience of the world and of oneself – the synthesis of the manyfold snapshots of someone’s experience 42. “The perceptual synthesis is a temporal synthesis”, – writes M. Merleau-Ponty 43. It would be impossible to experience oneself and the world as temporally continuous entities if our consciousness of the present moment were merely the experience of a punctual “now”. Consciousness of the present moment, thanks to the passive (i.e., spontaneous and involuntary) temporal synthesis described by phenomenologists, is rather experienced as having temporal “width” 44.
In the process of this synthesis, the body and, in particular, movement can play a fundamental role. We can argue, building on and extending Helene Cæcilie’s experience, that dance operates an embodied temporal synthesis which gives “width” and “form” to the dancers otherwise disintegrated Self- and world-experience. Dance operates a Gestaltung making up for the lack of spontaneous, involuntary, and “operative” temporal synthesis, which is at the basis of schizophrenic vulnerability and psychotic disintegration. Dance does not operate on an abstract, cognitive level; but on a concrete level – in the movement of a body, in the body in motion.
It is an act – the body in movement – that restores continuity and coherence to the experience of Self, space, and finally of the body and time itself. Embodied temporal synthesis operates through the movement of the body and restores continuity and temporal coherence to the Self, individuality, and boundaries in space, unity, and structure in the body, attunement with other bodies in movement, and at the same time, delimitation with respect to them.
Future research should help answer the question of whether Helene Cæcilie’s stance in the face of her psychotic disintegration – i.e., dance – can be taken as an example and generalized as a form of reintegration treatment for schizophrenia.