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Self Creation and Treatment

Patients do not need or want to be average but to supercede themselves.

An understanding of the kinds of creative thinking involved in art, literature, and science applies to the treatment of mental and emotional illness. Not just the performance of any specific therapy, but the medical management of such illness. To show how this is so takes me into the nature of mental illness impairments, the definition of creativity and creations in art and in life. I shall describe the independence, unearthing with self-knowledge, and partial destructiveness that is intrinsic to the creative process. I shall not—it has become important nowadays to say—propose that mental illness produces artistic creativity, a rather popular current notion for which there is no scientific basis at all.


Let’s first look at the fundamental issue of normality, a fairly straightforward physiological and physical matter but more complicated for psychiatric medicine. When a patient has pneumonia with cough, sputum, and fever, the patient and his or her organs are not functioning normally. To be normal, they must get back to their pre-pneumonia state. When the deficiency is corrected, patients will be ‘‘like everyone else’’, their lungs functioning healthily, just like the average—or just like the vast majority of people of their age.

With the treatment of mental and emotional illness, however, the notion of the average or the majority as normal (even in equality-loving and democratic cultures) is acceptable neither to patients nor practitioners. Mental health is not considered equivalent to being average or being the same as everyone else. Moreover, returning to average functioning or to a previous state may not suffice for ameliorating the illness. Once one develops a mental illness or disorder, almost invariably there are continuing problems. In a lesser way, this also applies to pneumonia. After having the infection and being effectively treated, the patient is never exactly the same as before. The diseased lung area is permanently scarred. Although minuscule, the residual scar remains for life.

Lung scarring is a deficit but the pneumonia will not by and large recur unless there is exposure to the infectious organism. With reasonable precaution, this can usually be prevented. For mental and emotional illness, on the other hand, the recurrence threat is greater because up to the present time human beings have not ever been able to prevent exposure to the social and environmental stresses and threats of everyday life. In attempting to help a patient return to functioning or coping or adapting, medication may be helpful but more is needed than can be accomplished with medication alone. With the scar of mental hurt and illness patients also need to be able to adapt better to their environments than others who have not been scarred at all.

Even if practitioners do not see things this way, patients inevitably do. Although it is difficult therapeutically to define what it means to adopt the goal of helping any given individual patient to get along or ‘‘to function,’’ the patient most often has already rejected the goal of simple functioning out of hand. Nor do patients accept the aims of ‘‘coping’’ or ‘‘adjusting’’ or even ‘‘adapting’’ very readily. Most want to be better than they were, better than others, and thereby better able to deal with the constantly problematic circumstances in which human beings live at the time or in the future. Both patients and therapists are oriented to, and engaged in, facilitating creation. Both are focused on the patient’s creation of his or her self or aspects of self—an ongoing process of self creation.


By self creation, I am speaking of something directly analogous to creation in the arts and sciences. In these fields, creation is most meaningfully defined as the production of something both new and valuable. In the process of achieving self creation through systematic case management, adjunctive or intensive psychotherapy, something new and valuable is also produced. Patients make themselves, or aspects of themselves, better than before. They break away from the past and produce features that are new. Medications provide reduction of symptoms and concomitant psychotherapeutic approaches should be processes of facilitating self creation for patients—the better the psychotherapy, the greater the degree of self creation.

A focus of choice on the patient’s present life may include measures of the past if the past has become restrictive. To the extent that patients become free from the past, and face the present more effectively, they are able to make new choices and adopt new alternatives. These choices arise from patients’ active decisions about what type of persons they are and what type of persons they want to be. There is freedom from the past, but there is also continuity with the past; patients create partly on the basis of what they know or sense to be the predetermined aspects of themselves. They accept factors in their past which cannot, or need not, be changed.

When a radically innovative artist, such as Cezanne, creates a new mode of painting, the work of art as a whole is not totally divorced from anything that was ever done before. We appreciate and understand the accomplishment of Cezanne partly because of ways that his paintings have links and continuity with the works of the Impressionists and other past artists. Many of Shakespeare’s most creative works also convey the meanings and the structure, as well as some of the drama, of the histories and stories on which they are based.

Self creation is a potentiality for everyone throughout the course of life development. Whenever we actively make choices leading to increased independence and better definition of our selves, including our wishes, strengths, and goals, and whenever we achieve improved personal integration—all matters of producing both newness and value—we engage in self creation. Creativity of all types is also often a response to upheaval and stress. This has appeared historically on a broad social scale when, in all fields and places, creative persons and events have arisen during times of chaos, war, and social disintegration. At the personal level, stress and upheaval, may often, as in mental illness, be a special spur for self creation during the course of treatment.


The process of self creation is not necessarily a smooth or constantly fulfilling experience. The chaos and stress that initiates self creation may, prior to its flowering, give way at times to greater disturbance. This is because creation and destruction, though opposites, are closely related to each other. Patients engaged in any therapeutic management may come to a point where they become preoccupied with destructive thoughts of escape, of feelings of unbearable struggle and surrender. These thoughts, however, may often signal a turning point; patients are confronting basic conflicts and the full brunt of fear of change. With sudden impact, they have come to see that the locus of difficulty is within themselves. Although the source of their problems may originally have been external—harried by an overbearing wife or husband, cursed by bad breaks or by faulty upbringing by unfeeling parents—they realize that only they can set things right. They know they must change themselves and they are terrified of change. They feel destruction or dissolution of features of the persons they have been and a simultaneous sense that they could make themselves totally into a person they wish to be.

Albert Rothenberg Picasso
Pablo Picasso used with permission
Source: Albert Rothenberg Picasso
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Source: Pablo Picasso used with permission

Creation and destruction are intimately related to each other both in life and artistic production. Pablo Picasso said, “Every act of creation is first an act of destruction.” Artists of all types knowingly set out to destroy a previous style by the creation of a new one, and producing anything radically new, in an essential sense, always involves destruction of the old. Although, as I said, works of art evolve from and connect with their precedents, their creative aspect, according to the definition, always involves newness and destruction of the modes and forms of the past and our ordinary ways of looking at the world.

Creative images and formal aspects of poetry shock our sense of grammar and syntax view, musical harmonics and arrangements our sense of sound and rhythms, and all forms of art, even representational productions, may change our view of color, shape, or simply the highpoints and relationships of a face or scene. Scientific creation, ranging from groundbreaking Einsteinian or Copernican theories to important and new understandings of immunosuppressive mechanisms, even more clearly results in radical change and destruction of existing beliefs and practices (See Rothenberg, A. Flight from Wonder: An Investigation of Scientific Creativity, Oxford U. Press).

One of the functions of artistic types of creation is the systematic unearthing of unconscious processes and the increase of self-knowledge. This is true to a lesser extent in scientific creation as well. Creation of all types has the potential for increasing self-knowledge and there is the possibility of creative persons freeing themselves from their psychological past and making themselves, or aspects of themselves, anew. In other words, creation in the arts and sciences, as in psychotherapy, can also facilitate self creation. As W.B. Yeats wrote:

Albert Rothenberg used with permission
Source: Albert Rothenberg used with permission

Those friends that have it I do wrong

Whenever I remake a song

Should know what issue is at stake

It is myself that I remake.

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