Reassembling the Self is a touring exhibition curated and devised by Susan Aldworth featuring work by herself and two other artists, Camille Ormston and Kevin Mitchinson. The exhibition’s theme is how psychotic disorders, especially schizophrenia, affect perception, emotion and identity. The exhibition, originally funded by Newcastle University, was previously shown to great acclaim at the Hatton Gallery and Vane Gallery, both in Newcastle (2012), and the GV Art gallery, London (2014). Through a research collaboration with Autifony and Newcastle University, academics at the University of Manchester become aware of the exhibition and participated in an educational event at the GV gallery. When it was announced that the exhibition would be shown at the Waterside Arts Centre, Manchester, between 7 February and 30 May 2015, a group of clinicians and researchers from the University of Manchester, led by Professor Jo Neill, Dr Peter Haddad and Dr Michael Harte, joined Jenny Waterson, Curator, and Kelda Savage, Freelance Curator and Events, to devise a series of supporting educational activities. These were promoted across various networks including press, education, health, science and arts organisations. In this article we review the exhibition and supporting events. From the outset public engagement and reducing the stigma of psychosis were key aims.
Reassembling the Self
The art work in Reassembling the Self was largely produced between 2010 and 2012 when Susan Aldworth was artist in residence at the Institute of Neuroscience, Newcastle University. Her work with neuroscientists, psychiatrists and patients led her to produce a series of striking lithographs that show dislocated anatomy highlighting how psychosis can distort the perception of self-identity. During her residency Susan Aldworth worked with Camille Ormston and Kevin Mitchinson, who both have a diagnosis of schizophrenia, to produce their own series of drawings and paintings depicting their experience of living with psychosis. This exhibition is the first time Camille and Kevin have publically exhibited their work. The work of all three artists vividly convey the emotional pain, distortions of the boundaries of the self and perceptual abnormalities that can occur in psychotic illnesses as well as the fragility of human identity. Space does not allow the full body of work in the exhibition to be reviewed, which has been done elsewhere (1), but we highlight three representative pieces.
Omston’s self-portrait and miles to go before I sleep shows her deep in thought, apparently oblivious to outside events represented by a chaotic choppy sea of blue. Her hair morphs into a chess board, a reference to her belief that life can often be a complex game.
Michinson’s self-portrait shows a masklike pencil drawing of his face, impassive yet sensitive. In stark contrast to this delicate sketch are a series of rays expanding from or perhaps going into his head and comprised of alternate black and red rectangles.
Memoirs is a short film by Aldworth based on Daniel Paul Schreber’s book Memoirs of My Nervous Illness (1903). Schreber suffered from schizophrenia and the film’s striking visual images include animated representations of his psychotic experiences including others contacting him using ‘divine rays’, his perception of two suns in the sky at the same time and of a multitude of ‘little men’ entering his body from the stars. The soundtrack, part of which was commissioned for the film, portrays his emotional response to these experiences which ranges from apparent terror to tranquillity.
The exhibition opened in Manchester with a well-attended evening reception featuring short talks by Bill Deakin, Professor of Psychiatry at the University of Manchester, and Susan Aldworth. Bill Deakin highlighted the impact of schizophrenia on individuals, families and society and emphasised that our understanding of the causes of the illness has increased considerably over the last 20 years. During the subsequent 3 months, over 3000 people have visited the exhibition in Sale. Their written comments show, not only that the art work was greatly appreciated, but that many were prompted to re-examine their own personal views on of mental illness.
In parallel with the exhibition, the Waterside Arts Centre screened three films with a mental health theme, each introduced by a psychiatrist. Two of the films were biopics. A Beautiful Mind tells the story of the Nobel Prize winning scientist John Nash while Shine is based on the life of David Helfgott, the Australian concert pianist. Nash and Helfgott suffered from schizophrenia and schizoaffective disorder respectively. The films show that any individual can develop psychosis, but that this is not an inevitable barrier to social recovery and a good quality of life. A Beautiful Mind vividly portrays delusions; it is only partway through the film that the viewer realises that Nash is suffering from schizophrenia and that much of his story that they have witnessed so far, with its themes of espionage and enemy agents, and even his best friend, represents his delusional system and not reality. The third film The Fisher King is less conventional, a drama set in New York in which the two principal characters have mental health problems, one suffering from what appears to be schizophrenia and the other from depression. The film shows how those with severe mental illness may be homeless, discriminated against and even physically assaulted. One scene vividly shows how frightening it can be to experience visual hallucinations.
All three films were box office successes and received critical acclaim going on to win 6 Oscars in total. Each portrays psychosis in a sympathetic light and depicts the individual affected as a complex multi-faceted character. In contrast many cinematic portrayals of psychosis revert to stereotypes, including the homicidal villain or the comic character to be laughed at, and in so doing promote stigma. The three films are not without their limitations in their depiction of mental illness, however it is important to remember that they are films and not documentaries. Film is a very popular and something that many people like to reflect on and discuss with friends. The more sophisticated and realistic representation of people with psychosis in these films is an important way to increase public understanding and reduce stigma.
blueSCI is a well-being organisation that supports people in their wellbeing through psychological interventions. They use a life recovery approach to help people rediscover skills, develop creative growth and social opportunities in wellbeing centres based in Trafford. As part of the events supporting the exhibition, blueSCI arranged a series of visits for people who hear voices to attend the exhibition. They subsequently explored their reactions to the art in workshops led by poet Jackie Hagan. A series of six postcards was produced, each with a picture from the exhibition and a quote from a participant on the reverse showing their response to the art. These postcards were available to visitors to the gallery, the aim being that the comments would provide further encouragement for visitors to consider their views and attitudes to mental illness.
During Mental Health Awareness week, Waterside Arts Centre hosted a 1-day symposium, organised by the University of Manchester, entitled Psychosis and Schizophrenia: Breaking down barriers and improving outcomes. The content was broad with varied format and included two short films, presentations by researchers, clinicians, the CEO of a creative arts and wellbeing centre and a service user and an interview with the father of a daughter who has schizophrenia. Several third sector organisations, that work with people with mental health problems, had stands at the symposium. The day was chaired by Professors Jo Neill and Bill Deakin who both highlighted the importance of ongoing research to increase our understanding of schizophrenia and to develop new and more effective treatments. The symposium was attended by service users, their relatives, members of the public, health care professionals and academics from a range of disciplines. All 150 places were booked in advance and in the days immediately preceding the event several extra places were created to accommodate family members following contact with the organisers. The format was highly interactive with question and answers after each session, an expert panel session and the use of audience keypad voting at the start and end of the meeting to assess participants’ attitudes to, and knowledge of, psychosis and schizophrenia.
Wayne Edwards’ account of developing psychosis and his subsequent recovery was exceptionally powerful and many subsequent speakers referred back to his story. In an interview, Dr David Shiers discussed his daughter developing schizophrenia and his subsequent work that was instrumental in establishing first onset psychosis teams in England and Wales (his daughter is willing for her story to be shared with others). Susan Aldworth reviewed the history of the exhibition, her inspiration for the project and its key works. Her talk, together with a presentation by Bernadette Conlon from ‘Start in Salford’, a community based arts project, highlighted how visual arts can be therapeutic for people with mental health problems and a valuable tool for public engagement and education. Professor Shôn Lewis delivered a wide ranging talk that challenged commonly held assumptions about pharmacological and psychological treatments for schizophrenia before reviewing the role of smart phones apps to enable people to monitor their health and communicate with their treating team. Other presentations included a clinical overview of psychosis and schizophrenia (Dr Richard Drake), strategies to overcome stigma (Dr Melissa Pyle), cognitive behaviour therapy for psychosis (Professor Tony Morrison), improving the physical health of people with psychosis (Dr Tom Tasker) and Avatar therapy, an experimental computer-assisted psychological intervention currently being researched in London (Dr Mar Rus-Calafell). The meeting also saw the first screening of a film made by a group of service users and mental health staff in Salford and Trafford in collaboration with a local filmmaker. It contains personal accounts of the lived experience of psychosis and aims to raise awareness about psychosis, reduce stigma and encourage people to seek help early (the film is available to view on YouTube).
Several key themes emerged from the expert presentations and audience discussion. The first was the cause of schizophrenia. Dr Drake highlighted that schizophrenia affects about 1 person in a hundred and is caused when a variety of risk factors come together – there is no single cause. Risk factors include the impact of several hundred genes, though individually each confers a very small risk. When one identical twin develops schizophrenia, there is about a 50% chance that the other twin will also develop schizophrenia, despite the fact that they have exactly the same genes. This shows that environmental factors are also involved in causing the illness. Known risk factors include birth injury, childhood abuse, being brought up in a city, cannabis use in young people and social stress including that associated with migration (2). Many people experience these factors and do not develop a psychotic illness. This shows that psychosis usually occurs when a combination of risk factors come together in a person who has a genetic vulnerability to develop psychosis when exposed to those risk factors.
A second theme, discussed in depth by Dr Pyle, was stigma. Stigma is best considered as being made up of three interacting problems, public ignorance or lack of knowledge about mental illness, negative attitudes to those affected and discrimination against them. Negative stereotypes of people with psychosis are common, especially in the media, and cause great distress for those affected. Some people with psychosis have referred to the associated stigma as being like having a second illness. Dr Pyle also emphasised the problem of self-stigma that occurs when negative stereotypes are internalised by a person with psychosis and which can lead to low self-esteem, shame and hopelessness. A service user in the audience highlighted that self-stigma continues to be a huge problem for him despite him having being free of symptoms of psychosis for many years. Tackling the stigma associated with psychosis requires action at many levels ranging from supporting and empowering individuals, though local policies to promote social inclusion to national and international strategies including public education campaigns and anti-discrimination laws (3).
A third theme, central to many of the presentations, was treatment (4). Most people with schizophrenia require care from a mental health team which provides help from a range of professionals. A positive therapeutic alliance with the team and ease of access to services are important elements for good care. There was a clear consensus that outcomes are better when people with psychosis engage in treatment early and that treatment needs to be individualised taking account of a person’s views and preferences. Antipsychotic medication is effective in schizophrenia but mainly in terms of treating the positive symptoms, such as hearing voices, and in reducing the risk of relapse. Medication has little effect on the primary negative symptoms of the illness, which include lack of motivation and a tendency to avoid others. Unfortunately some people do not respond to antipsychotic medication, or only show a partial response or find the side effects unacceptable. For these reasons other treatments are needed. Cognitive behaviour therapy (CBT), added to antipsychotic medication, has been shown to lead to further symptom improvement compared to continuing medication alone. Ongoing research in Manchester, led by Professor Morrison, is assessing the effectiveness of CBT alone versus antipsychotic medication alone versus the combination of both treatments in psychosis but the results will not be known for at least 18 months. Social activities and rehabilitation are of great benefit to many people and third sector organisations play a crucial role in providing these.
The presentations did not shy away from the difficulties and realities associated with schizophrenia including the fact that long term outcomes remain poor for a significant proportion of people and that access to treatments, especially psychological therapies and community based rehabilitation, is often limited. Nevertheless a recurrent message was that outcomes are often better than many clinicians perceive (5). Feedback from those who attended the symposium was overwhelmingly positive and the results of keypad voting showed that views about the prognosis of schizophrenia became more positive over the course of the day. An evening gallery reception, following the symposium, allowed further discussions in an informal environment.
Examples of written feedback from the symposium
- ‘’I feel more informed and less isolated as a mother of a son with schizophrenia’’
- ‘’Gave an optimistic portrayal which is most unusual. The media portrayal is always one of fear’’
- “I found everyone I talked with, including the speakers, friendly and accessible”
- “Thank you for a great day, I’m grateful for low cost of attending – most conferences are too expensive”
- “So pleased to hear the information – I’ve learnt a lot”
Reassembling the Self is a remarkable exhibition. The works are of high quality and vividly convey what it is like to experience psychosis. The exhibition in Manchester catalysed a series of outreach events including workshops, films evenings and a 1-day symposium. The feedback suggests that these events were successful in reducing public stigma and providing a more balanced and optimistic view of the prognosis of psychosis and schizophrenia.
The film on psychosis that was shown at the symposium, and made by a group of service users and mental health staff in Salford and Trafford, is available to view on YouTube
User friendly information leaflets, produced by the Royal College of Psychiatrists, and dealing with psychosis, schizophrenia and other mental health problems are available on the Royal College of Psychiatrists website
The Manchester exhibition of Reassembling the Self was supported by Arts Council England, Wellcome Trust, University of Manchester, Newcastle University, Waterside Arts Centre, Trafford Council, CIT (Creative Industries Trafford), Autifony and b-neuro and curated by Jenny Waterson. The 1-day symposium Psychosis and Schizophrenia: Breaking down barriers and improving outcomes was funded by University of Manchester and the Wellcome Trust and its content devised solely by a steering committee headed by Prof. Jo Neill and Dr Peter Haddad (other members: Prof. Bill Deakin, Dr Michael Harte, Prof. Tony Morrison, Jenny Waterson). Kelda Savage was responsible for advertising and marketing the exhibition and supporting events for Waterside Arts Centre. Additional support for the meeting was provided by Jessica Bowman, Denise Davidson, Ingrid Francis and Charmian Olner. Sainsbury’s in Sale donated refreshments for the opening event, symposium and gallery reception. Andrew Hodson and Jackie Hagan from blueSCI, in collaboration with Seymour Poets, organised the workshops linking service user responses to the exhibition artwork. The films evenings were introduced by Dr Ross Overshott, Dr Richard Drake and Dr Peter Haddad. The copyright for the film posters is most likely owned by either the publisher or the creator of the work depicted. The scaled down, low resolution images of the film posters in this article are reproduced from Wikipedia. They are included to provide a review and critical discussion of the use of the films in public education. It is believed that this use qualifies as fair dealing under UK copyright law.
- Martin C. Art as a therapeutic intervention in schizophrenia. The Lancet Psychiatry, 2014; 1(5):340.
- Stilo SA, Murray RM. The epidemiology of schizophrenia: replacing dogma with knowledge. Dialogues Clin Neurosci. 2010; 12(3):305-15.
- Thornicroft G, Brohan E, Kassam A, Lewis-Holmes E. Reducing stigma and discrimination: Candidate interventions. Int J Ment Health Syst; 2008;2: 3.
- Psychosis and schizophrenia in adults: treatment and management. NICE guidelines [CG178]. Published date: February 2014. Information for the public.
- Revier CJ, Reininghaus U, Dutta R et al. Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study. J Nerv Ment Dis. 2015; 203(5):379-86.