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Ashley Mowrey
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Approved by:
Joanna Pashdag, Ph.D., Chairperson
Arinn Testa, Psy.D.
ProQuest Number: 3728460
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a note will indicate the deletion.
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Acknowledgments
Joanna Pashdag. Without her patience, guidance, and unrelenting support this could not have
been possible. Her enthusiasm for novel ideas and concepts that push the boundaries of what
is conventional within psychology gave me the motivation to continue pushing through this
prolonged process. I would also like to also thank Dr. Arinn Testa for her feedback and
positivity throughout this endeavor. Her optimism and tranquility has inspired me to
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Abstract
theoretical orientation and the view of the client, it focused on broadening the literature
client and their mental illnesses. Using the artwork of individuals diagnosed with a mental
illness, this study examined psychologists abilities to identify mental illness in artwork.
Furthermore, this study examined characteristics that psychologists felt were indicative of
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mental illness and provided insight into how psychologists of different theoretical weigh
these characteristics for diagnostic purposes. This study found that psychologists in general
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were unable to differentiate between artists with mental illness and those without, and that
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there were no significant differences in their ability to make such differentiation. There was
orientation in regard to which aesthetic qualities they used to make such differentiation,
although Humanistic and Psychodynamic psychologists were slightly more likely than
Table of Contents
Page
List of Appendices....................................................................................................................V
List of Images..........................................................................................................................VI
Acknowledgments.................................................................................................................VII
Abstract..................................................................................................................................VII
I: Introduction.........................................................................................................................1
III: Methodology...................................................................................................................38
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IV: Results..............................................................................................................................48
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V. Discussion..........................................................................................................................53
References..............................................................................................................................63
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List of Appendices
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List of Images
Figure 1.................................................................................................................................102
Figure 2.................................................................................................................................102
Figure 3.................................................................................................................................103
Figure 4.................................................................................................................................103
Figure 5.................................................................................................................................104
Figure 6.................................................................................................................................104
Figure 7.................................................................................................................................105
Figure 8.................................................................................................................................105
Figure 9.................................................................................................................................105
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Figure 10...............................................................................................................................106
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CHAPTER I
Introduction
existence through which we enter via our own observations. Mental aberrations provide
access to internal authenticities of experience and core truths (Spaniol, 2001). We become
inhibited by our own perceptions; our elucidations therefore become a consequence of our
reactions to our experience of artwork. Akin to what Porter (2002) mentions in his book, A
Brief History of Madness, this study asserts that we lack an objective method of describing
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terminology to convey concepts in a generalizable and precise way to all. Our knowledge,
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regardless of the data provided, is subjective solely based on the individuality in which we
perceive and interpret what we read and experience. Research is deeply flawed, if the
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ultimate goal is to be purely objective, because each individual has their own filter through
Research into the validity of projective tests is extensive (Dalley & Case, 1992;
Groth-Marnat, 2009; Oster & Crone, 2004; Rubin, 2001; Ulman & Levy, 2001), but
projective testing lacks a foundational theory. Although disjointed, evidence does exist for
the use of projective tests, but there is no single theory that underpins them all. Additionally,
clinical judgment is a key variable in the scoring and effectiveness of projective tests. What
is lacking in this field is evidence that measures the accuracy and extent to which clinical
Beyond projective testing, a large scope of client data comes from personal artifacts
(e.g. clinical history, behaviors, work produced) and artwork has been historically viewed as
a human artifact rich in unconscious meaning and symbolism. Persons with mental illness
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may have significant artistic potential (Benjamin, 2008). There has been the supposition that
those with mental illness are able to portray a raw and unhindered representation of their
inner senses, allowing them to create images that sane persons would not be able to; the
artwork of those with mental illness are thought to have qualities that represent the
underlying mental illness. According to Beveridge (2001), at the beginning of the nineteenth
century, two movements ignited interest in the artwork of those with mental illness, the
Romantic Movement and the initiation of asylums madness during the romantic period
was deemed an honored condition and those with mental illness were the bearers of the
ultimate truth. Biographies of artists with mental illness have been cited in historical
literature, and have been based on anecdotes from the artists themselves, witness accounts of
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their irrational behavior(s), or theories from scholars who use the aforementioned sources
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as the basis of their theories.
Written accounts from prominent artists have been largely anecdotal, but currently
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trends in research have indicated that there are higher than chance correlations between
creativity, components of creativity, and mental illness (Jamison, 1995). Additionally, some
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studies have identified traits in artists that parallel the characteristics of those with bipolar
disorders and depression (Andreasen, 2005; Benjamin, 2007; Jamison, 1993; Runco &
Richards, 1997)
incentive to investigate whether the artwork of mentally ill persons differs from those who
are not mentally ill and what distinguishing factors differentiate the two. Psychological
issues drive acts of creativity and more often than not, artists are not consciously aware of
these issues or conflicts (Panter, Panter, Virshup, & Virshup, 1995). Rogers position was
that the difference between fantasy, as in dreams, and art, is that dreams are almost pure
primary process and art a combination of primary and secondary process (Rogers, 1978;
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Spaniol, 2001). Artwork provides clinicians with insight into the contextual framework of
their clients unconscious and allows access to repressed, denied, or malingered information.
In fact, Benjamin (2007) believes that the repression of artistic inclinations in someone with
a predisposition to divulge their unconscious through the medium of art will result in the
accuracy and applicability of clinical judgment regarding the appearance of mental illness in
art would provide the field of projective testing with a reputable tool by which test data and
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is their inability to identify response sets, including malingering (Hersen, 2004). Court
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opinions are biased against projective tests, defending their inadmissibility in court on their
inability to reliably and validly identify mental illness. In as the case of Wordsworth Irving
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v. State of Florida (1998), for example, the defendant appealed their conviction on the
grounds that the judge has wrongly allowed clinical judgment into the testimony, judgment
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that was based on projective tests that did not hold up to the Frye standard. The case was
reversed until the projective tests could be subjected to testing to indicate whether they met
the Frye standard of objectivity. The objectivity of scoring systems appears to be an illusion;
the value in projective measures resides in clinical procedures and judgment (Oster & Gould,
2004). The complication is that the subjectivity inherent in any interpretation of any
projective test ultimately means that no projective tests can be used in court without
providing the opposition an opening to lodge a potentially valid objection. What is missing
theinterpretation of subjective data via projective testing can be upheld under various
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psychologists ability to accurately score and interpret projective test data, as well as an
overall lack of confidence in their ability to judge mental illness through examination of
interpretation (Grove, 2000; Grove, 2005; Hallbower, 1955; Meehl, 1995; Meehl, 1957 );
this subjectivity is based upon the clinicians view of pathology and how people exhibit
projective test data and client artifacts. It is known that a psychologists theoretical
orientation is a personal choice dependent upon how they conceptualize their clients
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(Poznanski & Mclennan, 2003), how they convey themselves in their work with clients, and
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indicates the type of lens through which they interpret mental illness (Beutler, Malik,
Alimohamed, Harwood, Talebi, Noble, & Wong, 2004; Heinonen, & Orlinsky, 2013; Messer
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& Gurman, 2011). Research indicates that which theoretical orientation a psychologist picks
seen in their approach to clients, their beliefs about pathology, and their methods in
treatment (Murdock, Banta, Stromesth, Viene & Brown, 1998; Ogunfowora & Drapeau,
2008). Therefore, it can be argued that any material pertaining to the client would be
This present study asks whether psychologists are able to diagnose mental illness in
artwork. The study also introduces the notion that clinicians theoretical orientation affects
their accuracy in diagnosis. This study was conducted to examine the supposition that
regardless of the method of interpretation, there is a degree of intuition inherent in the people
who go into the profession of psychology that provides psychologists with the ability to
identify mental illness in nonverbal artifacts. Furthermore, it is the supposition of this study
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that theoretical orientation will mediate the accuracy of diagnosis; that is, in comparison to
based theoretical orientations will have a lower accuracy rate when attempting to diagnose
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CHAPTER II
Literature Review
This chapter will review the relevant literature pertaining to the development and use
of artwork as evidence in identifying mental illness in persons. In doing so, the motivation
for this proposed project will be supported. The first portion of this chapter will focus on
historical references to the mental illness of artists; it will cite art historians interpretations
of artists works and their impressions of how and what the artwork was portraying about the
artist. Secondly, this chapter will address literature supporting the connection between art
and mental health. Thirdly, this chapter will connect artwork with projective testing and
illustrate the importance of projective tests in the field of forensic psychology. Lastly,
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theoretical orientation will be investigated to illustrate how the differences between
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perspectives on mental illness influence how psychologists use artwork as a diagnostic tool.
Why Artwork?
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What is creativity? The definition itself creates a foundation for this study; art should
be considered a critically relevant portion of client artifacts and tool for diagnosis. According
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to Panter (1995), creativity is the ability to bring something new into existence it is the
world seen in a new way by being filtered through the eyes of the artist. According to Plato,
creativity is divine madness a gift from the gods (Plato, 1952, p. 129). Throughout
history, the perceptions of artists and non-artists alike has been that art is somehow tied to
the artists psychology, that it comes from within and creates an externally visual
representation of their inner beings. Similar to Freuds (1908) perspective, creativity is not
limited to conscious effort; creativity takes place in the unconscious (Halsey, 1977). Spaniol
automatic associations. Overall, Spaniol found that the creative processes of most of
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artists varied, and at the same time, a pattern in the use of blending of intention with intuition
This study was undertaken with the contention that the objective and
psychometrically restrained procedures used for identifying the minute complexities that are
(2003), who surveyed what psychological tests experts consider acceptable, 81% of experts
stated that projective tests were unacceptable to use in forensic evaluations. Due to the low
level of favorability for the use of projective tests, there is a need for literature designed to
develop more suitable, sensitive projective assessment measures. Advancement of the field
of projective testing requires defined and accepted reliable scoring categories (Hacking &
Foreman, 2001).
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One step in this process is to identify whether psychologists have a significant ability
to diagnose the presence of mental illness in individuals by examination of their artwork, and
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if so, whether accuracy varies depending upon the theoretical orientation. The quantification
of psychologists ability would provide evidence regarding the validity of clinical judgment
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judgment will allow clinicians to surmise data without attempting to standardize a rating
scale that is seemingly impossible given the numerous variables that go into subjective and
unconscious data. If a trait or ability in psychologists could be identified, one that allows
them to accurately identify mental illness in projective data such as artwork, then the validity
validity of clinical judgment in regards to projective testing would allow projective tests to
Art Therapy
procedures cannot account for the unique, personal expression of inner experiences.
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Physicians trained and practicing in art therapy appreciate the unveiling of a clients
functioning through interpretation of work collected via art based interventions. Client
artwork has the advantage of being interpreted by practiced clinicians, who look for patterns
that elucidate latent material that may be out of current awareness of the client and therefore
unable to be picked up by objective tests. The use of drawings assists the clinician in
making informed assessments and increases their diagnostic validity that is individualized to
clients specialized needs. These pieces of art represent symbolic demonstrations of the
Oster and Gould (2004) cited evidence from Gumaer (1984), who noted from his
experience in diagnostic work that someone who is defensive will display their lack of
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spontaneity in drawings by creating monotonous reproductions or preferring to trace rather
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than draw. This is one example of numerous incidents of overlapping themes and aesthetic
Aristotle opined (as cited in Hershman & Lieb, 1998, p.8), All extraordinary men
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distinguished in philosophy, politics, poetry and the arts are evidently melancholic. Plato
described four types of divine madness: poetic, prophetic, ritual, and erotic (Plato, 1952).
Since the 1900s, the notion of artwork as a representation of an artists mental status has
been illuminated in popular literature. Nordau, a German physician from the 1900s,
perceived cultural products such as music and painting to be the symptoms of disease
(DeLue, 2007). Nordau made a correlation between colors and diagnosis. For example,
Nordau believed that purple was linked with melancholia this color association provided
inspiration that other scientists sought to prove or disprove. Hartman, a critic and poet, took
inspiration from Nordau and applied this concept to impressionist artwork, stating that
greatness of the art might be a function of sight or minds not fully well (Delue, 2007).
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In the eighteenth and nineteenth century, the association between mental illness and
creativity gained currency as poets such as William Blake, Lord Byron, and Lord Tennyson
described their extreme mood swings (Jamison, 1995). As records have been easier to obtain
on the health histories of famous artists, more contemporary artists have been linked to a
history of hospitalizations for various mood disorders. Painters such as Van Gogh, OKeefe,
and Goya are some examples of well-known artists with substantiated mental illnesses
(Jamison, 1995). Additionally, Jamison examined biographical studies of artists and writers
and foundf an incidence of 18 times the rate of suicide, depression, and manic-depression
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life energy, and an integration of pieces of the creative persons existence. Creative action,
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according to Winnicott, is an action that stems from the creativity of being itself. A notable
study examined expanded the definition of creativity to encompass both those considered
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artistic and those who are not considered artists but still create art. The emergence of this
notion led researchers to investigate the associations of the creative process in ordinary (non-
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mental illness. According to Spitz (as cited in Person, Cooper & Gabbard, 2005, p. 501),
when a writer interprets art of the past, there is rarely any interpersonal context for evolving
and nonclinical academic authors, whom the former have often perceived as superficial and
interpretation of artwork.
In the early nineteen hundreds, Surrealism was beginning to form. Surrealist artists,
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while forming this stylistic divergence from traditional painting methods and content, were
influenced by Sigmund Freuds concept of the unconscious. Similar to the Romantic period,
mental illness or madness was glorified and upheld as a higher state of being, sometimes
perceived as being the ultimate form of elucidation, clairvoyance, and a way to see beyond
the confines of what was then the bourgeois class (Beveridge, 2001). What follows are
examples of art critics presumptions of the mental illness of known artists, as well as a brief
description of biographical data that corresponds to the evidence of mental illness that critics
Vincent Van Gogh. Richard Jed Wyatt of the National Institute of Mental Health has
argued that Van Goghs symptoms, the natural course of his illness, and his family
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psychiatric history strongly indicate manic-depressive illness (Jamison & Wyatt, 1991). The
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evidence includes the nature of Van Gogh's psychiatric symptoms (extreme mood changes,
including long periods of depression and extended episodes of highly active, volatile and
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excited states, altered sleep patterns, hyperreligiosity, extreme irritability, visual and auditory
hallucinations, violence, agitation, and alcohol abuse), the age of onset of his symptoms, his
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premorbid personality, the cyclic nature of his attacks, and his family history of suicide and
psychiatric illness (Jamison, 1993; Bhattacharyya & Rai, 2015). In letters to his brother
Theo, Vincent wrote, My youth was gloomy, cold and sterile (Parke, 2010, p. 70). Vincent
himself suffered from hallucinations and delusions, his brother had a psychotic episode
within several months of Vincents death, his sister spent 50 years of her life in an asylum,
and his mother was thought to have suffered from depression (Panter, Panter, Virshup &
Virshup, 1995; Sheon, 1983). Of his time in the psychiatric hospital St Rmy, Vincent wrote
The horror I had of madness before, greatly softened (Parke, 2010, p. 114).
Many writers have identified patterns in the stylistic differences amongst Van
Goghs paintings, parallel to what are thought to be the cycles of his manic and hypomanic
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episodes. Bogousslavsky and Boller (2005) assumed that Van Gogh might have had suffered
from bipolar disorder since he had been exhibiting phases of intense activity followed by
periods of extreme exhaustion and depression. Jamison (1993) looked at Van Goghs
paintings during different months of the year and identified a seasonal pattern. She stated
that the summer peak in productivity is consistent with what we know about his own
description of his frenzied moods and energy during those months of the year. Furthermore,
she stated that in November and Febuary, his images depicted the progression of Van Gogh
from a depressive state into a mixed state in December and January. Jamison and Wyatt
(1991) found that Van Gogh created the most paintings in June and July, giving evidence to
the cyclical nature of Van Goghs depression and the impact it had on his productivity.
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Van Goghs styles of paintings changed within the context of his relationships; as
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relationships formed his work became more vivid and intense and as his relationships ended
his paintings became dark. After his separation from Sien, a prostitute Vincent fell in love
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with, he transitioned from pen and ink to oils and his work turned dark in color and dreary in
mood this is considered by some to be a expression of his sadness and pessimism from the
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breakup (Panter et al., 1995). Within the first six months of the death of Vincents father, he
painted The Potato Eaters, a masterpiece that depicted a sad and hopeless family (Panter et
al., 1995).
Van Goghs relationship with Gauguin has been interpreted as the most influential in
his works. After Gauguin moved in with Van Gogh, according to Panter and colleagues, his
works began to suggest latent homosexuality in Vincents behavior toward Gauguin (Panter
et al., 1995). In Vincents Chair, the chair is described as strong and masculine, while in
Gauguins Chair, the chair is described as soft, curved, and being accompanied by a flaming
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Inner conflicts and desires have been seen in Vincents works. According to Panter
and his colleagues, Starry Night expressed Van Goghs turmoil and frenzy to maintain sanity
(Panter et al., 1995). They depicted Van Goghs illness as being exemplified in the clutching
branches of the cypress trees he painted this was an expression of Van Goghs fear and
longing. Also, considering Vincents use of the medication digitalis, a theory that is still
posited is that the side effects of digitalis poisoning yellowing of the vision and coronal
vision was the cause of Van Goghs Starry Night (Panter et al., 1995).
Wheat Fields Under Crows was one of Van Goghs last paintings and one that is
believed by many to be foreshadowing his suicide. According to Panter et al. (1995), the
crows give an ominous air to the painting. The vanishing point is reversed and consequently
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the point where the artist is standing is in front of the painting both of these, when put into
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the context of his subsequent death, are indicators of a man that is on the verge of suicide.
Alternatively, some historians suspect that Van Gogh was a victim of consumption of
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the deadly liquor absinthe for a very long time and that this underlies his penchant for the
deep and bright yellow color in most of his paintings. (Bhattacharyya & Rai, 2015; Jamison,
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1992; Loftus & Arnold, 1991). Bhattacharvva and Rai (2015) believe that Van Gogh may
have suffered from psychotism, defined as acting crazy and criminal,, suffering from
hallucinations, stupor, and having nightmares, due to his prolonged use of Absinthe (). It is
difficult to tease apart which of his ailments may have been causing the fluctuating styles of
his paintings the substance induced psychotic disorder, his bipolar disorder, or the collision
of the two.
began drinking at the age of nine, and was reported as being violent and having a low
threshold for frustration. He was described as having a tendency to withdraw and isolate
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inept, a poor athlete, and unable to fit in (Naifeh & Smith, 2015; Panter, Panter, Virshup &
Virshup, 1995; Pollock & Wysuph, 1970). According to Pollock and Wysuph (1970),
alternating with paralysis or withdrawal, and this constituted a basis for the assertion that
Rothenberg (2001) stated that psychiatric treatment brought about a period of improvement
during which a creative breakthrough occurred. Pollock was considered the innovator of
expressionism, bringing expressionistic style from France and integrating it into the art
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Pollocks Flame was a self-portrait depicting a young child. Art critics identified a
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emaciated, hollow-eyed, depressed, scared child. This was said to be influenced by Pollock
being a young child and dealing with starvation, drinking, and having psychological
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difficulties these themes and emotions were depicted through the use of chaotic and
in the treatment of anxiety disorders, and his stay in Bellevue Hospital after a breakdown six
months later, Pollock under pressure from his siblings began work with Joseph
Henderson, a Jungian Psycholanalyst. Henderson worked with Pollock for 18 months and
into Pollocks psychopathology for example, most drawings were described as being
jagged and impulsive, having agitated renderings of confused human and animal forms;
these distorted images are said to give insight into Pollocks inner world, set free by abstract
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forms of his images. Art critics posited this was his way of veiling his images, a way to
destruct the imagery and a representation of his destruction of himself (Panter, Panter,
Virshup & Virshup, 1995). These critics suggested that he received permission from the
surrealists during this period to articulate his unconscious, allowing his inner images to force
their way out. While he abstained from drinking in 1947-1950, Pollocks style changed
drastically; he began the Classical Drip Period in which critics believed he exhibited his
freedom from alcoholism and revealed a rhythmic energy that translated itself into paint.
During his relapse in 1951, Pollock faded into his black period. His work included no
color, it contained mutilated figures, and exhibted what critics would call an overall funeral
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look. According to biographical records of the time, Pollock found it difficult to paint, and
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being without his outlet his depression worsened (Shepherd & Levy, 2004; Solomon, 2001;
Overall, Pollocks imagery followed the progression of his alcoholism and his
depression. According to an interview with an interviewer two weeks before he died (as
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cited in Leja, 1990) Pollock indicated that he had been a fan of Freud and was considered by
others and himself a Jungian, and that his paintings were physical representations of his
drawings and Jungian imagery. Leja stated that the use of the Jungian unconscious assisted
Pollock for a time to cope with artistic and psychological difficulties. Pollocks wife
commented on how recognizable the imagery became in his paintings, although he was
famous for obscuring images. When his imagery became too clearly defined, he concealed it.
In the end he was in his black phase, which some see as a conscious denial to resolve
conflicts because it was too painful to look at himself (Panter et al., 1995).
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According to Naifeh and Smith (2015), painting was how Pollock pacified his inner
demons. According to Panter et al. (1995), his painting technique was the mirror to his inner
chaos, an attempt to express his rage in a way that he could safely present to the world. As
they stated, By dripping, urinating on the canvas, as he did on the world, he was attacking
Edvard Munch. Warick and Warick (2010) wrote a biography of Edvard Munch
that described the correlation between his artwork and mental illness. Edvard Munch was
infamous for his lifelong struggle with mental illness. According to Rothenburg (2001),
Munchs diagnosis of bipolar disorder with psychosis has been based primarily on his diary
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behavior that ended in a psychiatric hospitalization. (Heller, 1984, Rothenburg, 2001; Stang,
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1972). He was able, through his art, to retain some sort of equilibrium in regards to his
psyche. Like other artists, Munchs illustrative legacy illuminated an in-depth study in the
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According to Prideaux (2005), as a child Munch lost both his mother and sister to
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tuberculosis. Munch was left to the care of his father, an emotionally unavailable, depressed,
religious fanatic. Munch lost his youngest sister after she developed schizoaffective disorder
and was placed in a mental hospital. These losses set a precedent for Munch, creating a
Throughout his life Munch produced self-portraits that started in his teens and
continued throughout his adulthood. Art critics noticed similarities amongst the self portraits;
none of them showed him smiling, his mouth was purposefully tuned downwards, his
shoulders sagged, and multiple furrows showed in his forehead (Warick & Warick, 2010). In
The Sick Child, Munch depicted an event that occurred during the death of his sister. He
painted this picture six times in order to process the memory of his dying sister. According
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to Munch (as cited in Prideaux, 2005, p. 102) the only influences for The Sick Child came
from Munchs childhood and home life, as it depicted the suffering incurred by his loved
ones. Subsequent themes that reoccurred in his paintings included love, grief, despair,
The Scream, his most famous painting, was said by art critics to exhibit a
disintegrating fetus-like figure, an undulating sunset and coastline, and two vaguely drawn
human figures they stated it represented loss, the loss of self, loss of the day, and loss of
his parents (Warick & Warick, 2010). According to Munch (as cited in Prideaux, 2005, p.
167), while visiting Ekeberg with friends and watching the sunset, he experienced a moment
which he described as follows: suddenly the sky became blood and I felt a breath of
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sadness I heard a huge extraordinary scream pass through nature. Over a period of
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months Munchs visual hallucinations transformed into a work of art, beginning with a pen
and ink drawing and ending in a painting. Using homeospatial processes, defined as actively
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conceiving two or more discrete entities occupying the same space, a conception leading to
the articulation of new identities, Munch took initial pen and ink sketches that were inspired
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by his hallucination and transformed them into a piece of artwork throughout a yearlong
process (Rothenburg, 2001). What defined Munchs homeospatial processes was the
entities. This is what Rothenburg claimed was essential in the completion of artwork inspired
by psychoticism.
filled paintings. Warick and Warick (2010) cited paintings that illustrated Munchs
experience of women and relationships. Vampire illustrated a womans head being buried in
a mans neck, Harpy showed a birdlike woman tearing out a mans innards, and most
reminiscent of his difficulties were his paintings of a dying or dead mother with a child near