It’s not so much thinking out what to do, it’s the doing of it that sticks me

The pianist is stopped mid-cadenza as he suddenly remembers his fingers. The lover is recalled from ecstasy by a fractionally too great awareness that he needs to consult an erotic zone. The poem grinds into prose. The Goddess of Nature cedes to the Department of the Environment. It might be called a modern affliction: an excess of self-consciousness, a doing of things by rules, a misplaced hungering for certainty. In every sphere of life we find a new kind of attention imposed, drawn out from within the experience and directed at the idea of the experience. Nothing is spared.

The growth of excessive consciousness has profound consequences for the way we experience ourselves and the world. These consequences have been explored or expressed in much of the art and philosophy of the late 19th and 20th centuries, in what might be gathered together under the names of Modernism and Post-Modernism. The cult of the ironic, distanced observer, aware of his own awareness, unable to break out of his solipsistic construction of himself and his world, has displaced what is now seen to be the naive, immediate relationship with reality as it is felt. This point of view has developed its own orthodoxy, even if most of us go about our lives as though we were actually involved with things, events and people not entirely of our making.

Most of us – but not all. Imagine being so constructed that this excessive consciousness pervaded everything. The most intuitive acts become the object of exhaustive scrutiny. One’s own thought processes start to appear alien and bizarre. In the extreme case both feeling and acting eventually become impossible. About 1 in 100 people world-wide lead lives shaped by this strange affliction: schizophrenia.

I am not sure of my own movements any more. It’s very hard to describe this but at times I’m not sure about even simple actions like sitting down. It’s not so much thinking out what to do, it’s the doing of it that sticks me.

People just do things but I have to watch first to see how you do things.

I have to do everything step by step, nothing is automatic now. Everything has to be considered.

Schizophrenia has nothing to do with split personality. The phrase might be better rendered as ‘shattered mind’. Indeed, the word ‘shattered’ picks up well one of the condition’s cardinal features: the loss of the faculty of seeing things as a whole – the loss, to use the old psychological term, of the Gestalt – so that the whole of reality becomes, like Coleridge’s description of the cosmos, ‘an immense heap of little things’. Everything has to be broken down into parts. Thought processes lose their coherence; emotions are absent altogether or, similarly, fail to cohere. Most strikingly, there is an altered relationship with external reality, characterised by delusions and hallucinations: what is ‘real’ becomes uncertain, nothing can be trusted, the world becomes frightening and alien.

What schizophrenics experience might, then, be viewed as an extreme version of the mental world of the alienated intellectual. To understand quite how extensive, and how important, the comparison is, you need to read Louis Sass’s wholly fascinating Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought, and The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind.

Sass is a professor of clinical psychology and Madness and Modernism is rooted in a thorough knowledge of the psychological literature, but he also draws on an extensive acquaintance with 19th and 20th-century art, literature and philosophy. Both books are powerful, lucid and original, and they should revolutionise our thinking about the workings of the human mind.

The Paradoxes of Delusion is the shorter and, in the technical sense, more philosophical work. In it Sass explores the idea that ‘madness ... is the end-point of the trajectory [that]consciousness follows when it separates from the body and the passions, and from the social and practical world, and turns in upon itself.’ To Sass, as to Wittgenstein, there is a close relation between philosophy and madness. Sass argues that the philosopher’s ‘predilection for abstraction and alienation– for detachment from body, world and community’ produces a type of seeing and experiencing which is, in a literal sense, pathological. His concern is the transformations which come over our understanding of the world when we cease to be involved and instead become passive, disengaged, self-conscious, ‘objective’.

Throughout this book, like the interwoven strands of some counterpointed duet, run the introspective reflections of two highly intelligent individuals, one a philosopher, the other a certified madman. The philosopher is Wittgenstein. The other is Daniel Paul Schreber, an appellate judge in late 19th-century Dresden whose detailed accounts of his experience of paranoid schizophrenia became the focus of Freud’s only major study of a psychotic illness, and were extensively explored by Bleuler and Jaspers. Schreber was mad in the recognised sense: as with many other schizophrenics, his actions appeared to him to be controlled by rays, often people were cunning simulacra of human beings, it seemed that he was turning into a woman, and so on. But, Sass maintains, even these phenomena make sense if we come to understand the excessive consciousness which characterises schizophrenic thinking.

Sass does not see madness as the simple malfunctioning of reason, nor does he strive, as some have done, to glamorise it as an inspired alternative to reason. The delusions of schizophrenics are not failures of reasoning, but of appropriate feeling. ‘I used to cope with all this internally, but my intellectual parts became the whole of me,’ says one patient. Madness, in Sass’s view, is ‘to be sure, a self-deceiving condition, but one that is generated from within rationality rather than by the loss of rationality’.

Wittgenstein’s own ‘anti-philosophy’ is seen as an attempt to restore sanity to the philosophical mind caught up in the hyperconsciousness of metaphysical thought. He noted that when we act or interact – simply, perhaps, walk about in our surroundings rather than sit still and stare at them – we are obliged to reckon with the ‘otherness’ of things. As Sass puts it, ‘the very weight of the object, the resistance it offers to the hand, testify to its existence as something independent of will or consciousness,’ while moving an object ‘confirms one’s own experience of activity and efficacy’. By contrast, in Wittgenstein’s phrase, ‘staring is closely bound up with the whole puzzle of solipsism.’ The detached, unmoving, unmoved observer feels that the world loses reality, becomes merely ‘things seen’. Attention is focused on the field of consciousness itself, not on the world beyond, and we seem to experience experience. In the Philosophical Investigations, Wittgenstein notes that when such ‘seeing-as’ takes over, other people appear to be automata rather than minds: a common experience in schizophrenia and a core experience of Schreber’s.

The relationship between schizophrenia and modern thought goes beyond philosophy proper. Kafka, for example, notes in his diary how introspection ‘will suffer no idea to sink tranquilly to rest but must pursue each one into consciousness, only itself to become an idea, in turn to be pursued by renewed introspection’. The process results in a hall-of-mirrors effect. Spontaneity is lost and disorganisation and fragmentation follow. What is called reality becomes alien and frightening.

There are a number of paradoxes here, especially for the writer. All-powerful creator, he is himself a literary figment, at once entirely subjective and wholly objective, espousing simultaneously the extremes of literal-minded concreteness and particularity, on the one hand, and disembodied abstraction and generality, on the other. Sass sets out to explore these apparent contradictions by examining schizophrenic delusions.

He starts from what every clinician sees. A schizophrenic who apparently believes that she is the Queen Mother lines up patiently for her lunch on the ward. Another, who denies flatly that he has an illness, and smiles indulgently when you suggest that the voices in his head are not produced by engineers but come from his own mind, nonetheless asks for an increase in anti-psychotic medication because ‘the voices arc getting worse’. How can this be? Schizophrenics are preoccupied with their abnormal beliefs and experiences, and cannot be parted from them, yet they treat them with irony, and for the most part do not act as though they were real (though sometimes, importantly, they do). Sass describes this as ‘double book-keeping’. He sees it as resulting from a highly unstable solipsism. Deprived of any sense of the reality of consensual experience, the subject necessarily apprehends the world as a product of his own imagining. Yet at the same time the coherent central core, the experiencing ‘I’, itself appears as an object, limited and directed by something outside its own control (Schreber’s rays). The self is both omnipotent and powerless. Subjective and objective collapse into one another. The instability of solipsism reflects its intrinsically self-contradictory nature. Wittgenstein notes that for the statement ‘all that is, is mine’ to have any meaning implies that it might have been otherwise, that there is an other, unless the statement is to collapse into the tautology ‘all that is mine, is mine.’ Even the attempt to convince others of the truth of the solipsist’s position implies its own contradiction.

How does this solipsism arise? The answer brings one back to the way in which schizophrenics attend to the external world. It seems that something interferes with the broad scope of attention whereby many of our thoughts and perceptions are experienced as a whole. Instead, there is often an intense, narrow, focusing of attention on some quite everyday object or event, which renders it strange, inhuman, perhaps threatening. Detail is emphasised at the expense of the whole. Understanding what something denotes is not normally impaired, but con-notativc meaning may be completely lost. Predicted patterns are neglected, and the usual assumptions about what is going to happen on the basis of what has happened are not made. The net effect is to produce a sense of alienation from others, from one’s feelings and even from one’s own body. In his later book, Madness and Modernism, Sass draws extended parallels between the effects of these abnormalities of attention in schizophrenia and the nature of Modernist and Post-Modernist art and literature. What he aims to achieve is what Wittgenstein called ‘the understanding which consists in seeing connections’, the use of analogy to make things make sense in a new way, rather than the tracing of a causal relationship.

Ulrich, the anti-hero of Musil’s The Man Without Qualities, describes being so aware of ‘the leaps that the attention takes, the exertion of the eye-muscles, the pendulum movements of the psyche’ occurring at every moment that just keeping his body vertical in the street is a tremendous effort. This puts one in mind of the psychologist Chris Frith’s identification of one of the core abnormalities in schizophrenia as being the attempt ‘to perform a normally automatic process consciously’. The drawing together of the fragments of experience, the relating of them to memory and emotion, and the ability to feel them concretely and immediately – these are what givemeaning to our experience. The heart of Sass’s contention is that an excess of self-consciousness, with a corresponding accent on cerebrality, leads to a distancing of the self from reality – the predicament of Musil’s Ulrich – and to a loss of meaning.

‘What has arisen is a world of qualities without a man, of experiences without someone to experience them ... the belief that the most important thing about experience is the experiencing of it, and about deeds the doing of them, is beginning to strike most people as naive.’ The inability to inhabit one’s own experience described by Musil conveys both the strange sense of emptiness and alienation of the schizophrenic and an important element in some Modernist and Post-Modernist perspectives. The philosopher John Searle’s battle for the rediscovery of the mind aims to place the fact of the experiencing ‘I’ once again at the centre of our vision. One of the many paradoxes to which Sass directs our attention is that, as our sense of ourselves has become more and more narrowly identified with cerebral consciousness, the ‘I’ that underwrites that consciousness has come to deny its own reality. Like schizophrenics, we oscillate between omnipotence and impotence. Everything we experience we create ourselves, yet on closer inspection those selves turn out to be a mirage.

What we find when we turn our attention inwards is to a large degree determined by the fact of introspection, as well as by the expectations with which we set out. It is not surprising, therefore, that having banished from the field of view all but the algorithmic processes of cerebration, we should find on introspection that the mind is like a computer. Schizophrenics routinely see themselves as machines – computers and cameras are the most common – and sometimes complain that parts of them have been replaced by metal or electronic components. One that Sass quotes typically thought he might be a photocopying machine and another thought of cutting his veins to see if they contained motor oil.

This loss of what Sass calls the ‘sense of grounding in the lived body’ carries over to others, who are seen as not really experiencing, but merely counterfeiting, feelings. One patient ‘perceived the actions of his wife – a vivacious and lively woman – as those of a kind of robot, an “it” devoid of inner life. If he told his wife a joke and she (“it”) laughed, this showed no real feeling, but only her “conditioned” or mechanical nature.’ This is a dangerous view extending beyond the world of schizophrenics: its effects are apparent wherever it is tempting to see living beings as mechanisms.

Schizophrenics describe an emptying out of meaning – each word ‘an envelope emptied of content’, as one patient puts it, with thought become so abstract as to attain a sort of ineffable vacuity. They may feel themselves entirely emptied of emotion, too, except for a pervasive feeling of anxiety or nausea in the face of the sheer existence of things. Bizarre, shocking and painful ideas or actions may be welcomed as a way of trying to relieve this state of numbed isolation. Sass compares Artaud’s ‘I can’t even find anything that would correspond to feelings,’ and suggests that the ‘theatre of cruelty’ was a response to this devitalised condition: ‘I wanted a theatre that would be like a shock treatment, galvanise, shock people into feeling.’

In this anaesthetised condition, the immediate sense of our bodily selves, and the world which they inhabit, recedes. ‘The least important thing in my life is its tangibleness.’ So wrote Mary MacLane, a schizophrenic patient, in her memoirs. For schizophrenics like Judge Schreber, the physical does not fit with the rest of experience. ‘Body and soul don’t belong together– there’s no unity,’ says one patient eloquently.

This lack of grounding causes schizophrenics to veer between extremes of abstractness and literal-minded concreteness. Sass refers to this as disturbance of distance, and it has its parallels in Modernist and Post-Modernist art. Conceptual art yields obvious examples of movement into the abstract. On the other hand, Clement Greenberg’s description of the flatness of the canvas as the goal of modern painting focuses attention on the ‘literalness of the picture-surface’. But abstractness and concreteness are not polar opposites: indeed, they are aspects of the same thing. A urinal, a pile of bricks, considered as works of art are at the same time unusually concrete and unusually abstract. Attention is focused on the medium, not on the world beyond, which is effectively denied. The self-reflexive tropes of Post-Modernist literature and criticism concentrate attention on language, and undercut the sense of a world beyond language – the sense we would find in Wordsworth, for instance, but not in Mallarmé.

For schizophrenics, as another patient puts it, ideas often ‘possess a higher affective potential than immediate external stimuli such as persons or things’. Sass compares this to the condition of Nietzsche’s modern intellectual, his Don Juan of Cognition, relentlessly pursuing knowledge until at last ‘nothing remains to be hunted but the most agonising effects of knowing’ itself. Irony is a defining characteristic of Post-Modernism, with its mocking exploitaton of conventional forms, but it is already present in an earlier Modernist taste for what Ortega y Gasset called ‘a ban on all pathos’. Sass sees something similar in the disconcerting, somewhat fatuous, sardonic superiority of the schizophrenic patient. Such an ironic stance, he suggests, may be a way of disowning one’s actions or distancing oneself from one’s destiny, but it may also simply be a reflection of the fundamentally awkward alienated, schizoid character. In fact, both are probably true.

In some modern art and criticism, irony of this kind has a protective function. In Bioy Casares’s The Invention of Morel, any bonds we may begin to form with the characters, or even which they form among themselves, are disrupted by the clawing awareness that they are figments created by a machine which may itself be illusory. Dislocations of perspective, as in Faulkner’s The Sound and the Fury, enforce distance from the unfolding events. Calvino’s if on a Winter’s Night a Traveller sets up narrative expectations which are constantly undercut. Irony enables one to escape the vulnerability – the ‘embarrassment’ that Christopher Ricks identified in Keats– which comes from disclosure. The retreat into a self-referential, self-validating domain is another form of protection, but this safety produces what Sass calls ‘a distinctive combination of superiority and impotence’.

The process of distancing is often associated with ‘objective’ or affect-free attention – a sort of staring – either turned in on one’s own thought processes or directed at others. In his journals de Chirico, whose early paintings were a seminal influence on Surrealism, describes staring around him in the courtyard of the palace at Versailles, until ‘everything looked at me with a strange and questioning glance ... everything was inevitably there, but for no reason and without any meaning.’ This vision or state of mind, fraught with unfocused meaning yet imbued with meaning lessness, is highly characteristic of schizophrenia, and was actively cultivated by the Surrealists, sometimes by meditating on de Chirico’s paintings. Similar dreams or epiphanies were described as important by many writers earlier in the century – Sass points to Rilke, Hofmannstahl, Musil, Kafka, Nietzsche, Breton and Sartre.

Turned inwards, this stare fragments consciousness into a succession of disconnected sensations. Turned on others, it objectifies them by a dehumanising obsession with detail. Robbe-Grillet’s ‘The Secret Room’ consists of a series of static descriptions of a woman’s corpse. Its clinical detachment expresses better than any purely abstract art the triumph of alienation over feeling. The stabbed corpse could be said to stand in for the body in general, and its fate at the hands of Modernism. This story and a number of others are carefully compared by Sass with characteristic schizophrenic discourse. The parallels include the lack of a cohesive narrative line, neglect of conventional space-time structure, loss of comprehensible causal relations, and disruption of the symbol-referent relationship. Schizophrenics emphasise the static, and downplay emotional and dynamic, aspects of the world, evoking a universe more dominated by objects than by processes and actions. Patients with affective psychoses – manic depressives – do just the opposite, often to the same extremes.

Much Modernist and Post-Modernist art is seen by Sass as reaching for control over the more threatening aspects of reality. At the same time it is forced to recognise that such control is, in the end, illusory. One response to this is to assert that the whole thing – the threat and the means of neutralising it – is a game. When artists and critics speak of the ‘ludic’ in art, it may sound innocent enough. But one might instead see it as an uneasy power-game, played out by the artist or critic with his audience. It is familiar to psychiatrists because of the way psychopaths use displays of lack of feeling – a jokey, chilling indifference to subjects that normally evoke strong emotions – to gain control of others and make them feel vulnerable. If others show their revulsion, their vulnerability becomes obvious; if they do not show it, they have been compelled to dissemble, thus tacitly confirming the bully’s power.

How does the parallel between 20th-century art and schizophrenia come about? Are schizophrenics perhaps more creative? A few artists of the modern era were diagnosed as schizophrenic – Artaud, for example; others may have eluded diagnosis, but the connection has to be something more than this: one still has to explain the robustness of the parallel in the work of artists who weren’t formally schizophrenic. And if it were simply a question of artists tending to be schizophrenic, or of schizophrenics tending to be artists, the characteristics of 20th-century art should apply across time, which they don’t.

One response to this, which Sass entertains, is that schizophrenia, unlike manic-depressive psychosis, may be a recent disease. But the evidence is divided, and even if it is a modern disease, it appears to have existed at the beginning of the 19th century, in the heyday of Romanticism. In fact, there is evidence to suggest that it may at present be actually declining in prevalence, so there is still a good deal of explaining to do. The link between manic-depressive illness and creativity is well-attested, but the thinking of schizophrenics is commonly too severely disturbed and the capacity to plan and control too severely compromised for the creation of works of art, and the deficits are chronic, rather than, as in manic-depressives, fluctuating or episodic.

Nonetheless, there are characteristics of schizophrenia which might, in their milder forms, be useful to writers and painters. Sass contrasts the ‘look’, which examines objects that have a prior claim on our interest, with the ‘stare’, which makes things interesting by the very fact of being looked at. This staring attention is highly characteristic of schizophrenia, where apparently random facts or objects take on an unspecifiable significance, and in Modernism produces what Erich Heller (talking about Rilke) described as ‘the inflationary increase of significances’ – meanings and symbols loose from their moorings, which point reflexively to meaningfulness and the symbolic. Then again, schizophrenics may have an advantage in tasks which require breaking free from normal conceptions and accepted practices. Their fluidity of perspective is peculiarly congenial to some forms of Modernism and Post-Modernism, in which an impersonal novelty based on disconcerting perspectives supplants the Romantic cult of originality founded in the personality and ‘inner life’ of the artist. Nonetheless, there is a sort of slipping of gears in schizophrenia, with inchoate feelings and language free-wheeling together, resulting for the most part in something which observes the forms of creativity, without itself being creative: poeticising instead of poetry, mysticalese instead of mysticism, jargon instead of philosophy.

It may be tempting to retort that schizophrenia is a social construct which describes ways of thinking and behaviour we choose to consider abnormal, and which may be induced by the nature of 20th-century life. If true, this would collapse the apparent parallel between the two distinct entities – schizophrenia and modern thought – into a simple identity, leaving nothing to explain.

Twenty or thirty years ago it was still possible to hold this view, if you did not look too closely at the facts, but it is no longer possible today. Interaction with environmental factors is important, but there is now a mass of evidence of constant neuropsychological deficits, and differences in brain structure and function, together with clear evidence of genetic transmission in many cases, which while not all applying uniformly to every patient, make the simple social construct argument untenable.

Since Sass, perhaps wisely, leaves the question of the connection between schizophrenia and Modernism unanswered, let me speculate. Schizophrenia is not an all-or-nothing condition. We know there is a strong genetic component in many cases, but when the ‘gene’ for schizophrenia is found it is likely to be not one but several genes, each producing different neurodevelopmental effects. The families of schizophrenics, whose members share some, but not all, of the genes of their affected relatives, contain higher than normal numbers of individuals, usually males, with a kind of ‘watered down’ form of schizophrenia.

These individuals, known as schizotypal, have some of the abnormalities of attention I have been discussing. They also have abnormal affect, difficulties in socialising, and lack some of the warmth, humour and common sense which we would consider ‘normal’. They tend to be technically minded, though they are often attracted to magical and fantastical ways of thinking – classically, science fiction and the occult – and they may be unusually creative in certain ways. What they do not exhibit is the complete loss of touch with reality, characterised by delusions and hallucinations, which occurs in many schizophrenics. Individuals with such a make-up may have qualities which facilitate creativity, without the severe limitations of schizophrenia itself. Besides Nietzsche, Kafka and Wittgenstein, Sass includes, among others, Baudelaire, Van Gogh, Raymond Roussel, Jean-Pierre Brissct, Gérard de Nerval, Alfred Jarry, Strindberg, de Chirico, Dali and Beckett.

Some aspects of late 20th-century life in the developed world– the distancing effect of technology and bureaucracy on our apprehension of others, the barrage of disparate information and surrogate experience – reproduce traits that are easily identified in schizophrenics: the tendency to abstraction, or to hyper-consciousness, the concentration on detail rather than the whole, the perception of people and objects as mechanical entities. These, indeed, are the most obvious emergent forms of attention in Western societies, which may be why the work of many artists has reflected them, and why certain types of individual have prospered in that world. A few schizophrenics, and many more schizoid or schizotypal individuals, will have been naturally selected – self-selected – into the roles which shape and reflect our culture.