A Case study in sleep paralysis: Rosie

In our assessments of sleep paralysis we came to understand there is a link between sleep paralysis and certain disorders including anxiety, general stress and sleep apnea. The following is a brief diatribe wherein I suggest that there is a greater link between those with schizophrenia and schizophrenia like disorders, who have also been diagnosed with sleep apnea, and sleep paralysis. In particular, I will be providing a brief case study of one client and her apparent symptoms. It must be noted here before proceeding that the suggestions made in this paper are speculative in nature: I can not ascertain their validity or reliability without further assessment and deeper analysis. All qualifying personal information has been removed to uphold confidentiality.

Rosie

Rosie is a geriatric African-Canadian living with an intellectual disability and she has been formally diagnosed with schizoaffective disorder bi-polar type, chronic obstructive pulmonary disease (sleep apnea), and she exhibits obsessive compulsive like behaviours.

She exhibits typical symptoms for her diagnosis including delusional thought (including persecutory delusions), visual and auditory hallucinations, blunted affect, and alogia. She experiences intense mood swings which invariably affect her behaviour, and she has a general negative attitude. This is particularly exhibited in relation to herself, as well as in her relationships with others. She does not appear to put much faith in others’ reliability or loyalty. It is difficult for her to form and maintain relationships, and she is often closed off from others. In times of great stress she will express her anger and frustration with self harm, screams, shouts, expletives, and eventually aggression towards others. This sort of anxiety can be mediated successfully with anticipatory interventions, and due to her propensity towards anxious states it is best to avoid causing more anxiety or stress.

When Rosie is experiencing a hallucination she appears engrossed in the event as if she is watching a film. It is difficult to pull her from this engrossment and she pays little attention to voices and actions outside of the hallucination. She has demonstrated interaction with her hallucinations through her actions and her speech. At times it appears she is talking to herself, when it is more likely that she is actually communicating or interacting with her hallucination. She does not appear to be negatively affected by these hallucinations or delusions, during the day.

It appears that the ferocity and frequency of her hallucinations increase throughout the day, peaking particularly prior to sleep. I am not sure if this is due to added stress about completing nighttime routine, the thought of sleep, or anticipation of increased hallucinatory experiences.

Rosie uses a continuous positive airway pressure (CPAP) machine on a nightly basis. She averages 12 hours of sleep a night, but it appears this sleep is interrupted. This being due primarily to her sleep apnea and COPD. It is my estimation that her hallucinations worsen during sleep, and that this invariably contributes to her interrupted sleep. Not only does this contribute to disrupted sleep, it contributes to her heightened anxiety and stress related to sleep. This in turn increases the likelihood of more hallucinations. I am not sure if these hallucinations stem from her schizoaffective disorder, or if they more likely are linked to sleep paralysis. I can not confidently determine one way or the other.

In moments of sleep paralysis, the dreamer typically is witness to hallucinations, particularly insidious and persecutory hallucinations that cause great fear and stress. In these moments the dreamer tries to escape the situation. Due to the their vividness, these hallucinations appear real, instilling great fear in the one experiencing them.

As Rosie sleeps and dreams she shouts, uses expletives, and screams. Upon arriving to her room to offer assistance, she can be seen with her body twitching, convulsing and thrashing gently. It appears as if she is trying to wake herself up. These may be nightmares, but it is my estimation that she is in fact experiencing sleep paralysis related hallucinations.

I am led to believe this because of the sheer intensity of these hallucinations in comparison to those experienced throughout the day. They appear to be much more intensely felt, and she appears to be much more fearful of these. This indicates to me that they are outside of the realm of normalcy for her. Her attitude towards these hallucinations is that of concern and fear, and it appears as though she is trying to escape the situation both physically and mentally: evidenced by body thrashing and twitching upon regaining control of the body.

Further evidence points towards Rosie’s condition as being related to sleep paralysis. Hishikawa and Shimizu (1995) inform us that motor paralysis due to REM sleep can cause breathing difficulties, including what may appear like choking or suffocating. It may feel as if there is a weight or pressure on the chest, making it difficult to breathe deeply without feeling as if one is being suffocated. This is interesting to note because Rosie has been diagnosed with COPD. Could these feelings also be intensified through sleep paralysis? We know sleep apnea to be one disorder that contributes to the onset of sleep paralysis. While Rosie is diagnosed similarly, could this be contributing to her (as of yet undiagnosed) sleep paralysis? Simply put, her pre-existing breathing condition contributes to sleep paralysis, and her sleep paralysis contributes to her breathing condition, ad infinitum.

Although this information helps us in conceptualizing her sleep paralysis condition, what we are most interested in is the hallucinatory components of sleep paralysis, in particular Rosie’s nighttime hallucinations. I am unable to confirm sleep paralysis as a primary diagnosis for Rosie. Sleep paralysis at this point is mere speculation based on variance in hallucination profile from day to night, the intensity of the hallucination, and the apparent escape tactics used while experiencing these hallucinations. I do believe however, that due to the constant state of stress and anxiety Rosie is in daily, along with her diagnosis of COPD/sleep apnea, that it would be highly likely for her to experience sleep paralysis from time to time. Anywhere from 8% to 44% of people will experience sleep paralysis at one point in their lives, and according to psychologists at Penn State and Pennsylvania University, sleep paralysis occurs more frequently in students and psychiatric patients (Penn State News, 2011). Further, the sleep paralysis project reports that sleep paralysis more often occurs in African American individuals (www.thesleepparalysisproject.org). These statistics do not determine with any clarity that Rosie is in fact experiencing sleep paralysis, they merely contribute to my belief that she is.

In order to determine if Rosie is experiencing sleep paralysis we would need to study her case much further. We are still left with three unanswered questions. Does Schizophrenia contribute to sleep paralysis hallucinations (and what should we consider the primary diagnosis: sleep paralysis or schizophrenia?) Are hallucinations experienced by persons diagnosed with schizophrenia and schizophrenia like disorders more vivid, insidious or threatening in sleep paralysis? And does schizophrenia heighten one’s awareness of hallucinatory experiences, thus making it not only more likely for a person with schizophrenia to experience sleep paralysis, but for them to also be more aware of the accompanying hallucinations?

We are left wondering if the diagnosis of schizoaffective disorder is correct, or if perhaps hallucinatory complications arise due to sleep paralysis. Constant stress and anxiety contribute to sleep paralysis, and sleep paralysis is accompanied by hallucinations. We must consider daytime hallucinations. These could be explained by hypnagogic sleep paralysis: sleep paralysis which occurs prior to sleep. It would make sense for Rosie to be in a constant state of exhaustion due to her disrupted sleep caused by COPD. This could be cause for a general lethargy, perpetuated of course by anxiety and stress. The cycle of over-tiredness due to the avoidance of sleep or experiencing disrupted sleep is continuous and unrelenting. This lays way for sleep paralysis and hallucinations, the fear of which contributes to the avoidance and disruption of sleep.

Due to our prior observation that daytime hallucinations appear different from nighttime hallucinations, it would not make sense for us to dismiss schizoaffective disorder as the primary diagnosis. Although I am sure upon further analysis we could make a compelling case for why daytime hallucinations occur, and are experienced differently from nighttime hallucinations, we will not expel resources to do so now.

Rosie is but one case of many, and I believe it is important to conduct further research into the relationship between schizophrenia and schizophrenia like disorders and sleep paralysis. I propose some of our questions would be answered, and upon uncovering these answers we would lay way for many many more questions.

References:

Hishikawa, Y., & Shimizu, T. (1995). Physiology of REM sleep, cataplexy, and sleep paralysis. In S. Fahn, M. Hallett, H.O. Lüders, & C. D. Marsden (Eds.). Advances in neurology (Vol. 67, pp. 245-271). Philadelphia: Lippincott-Raven.

Psychologists chase down sleep demons. (2011). Retrieved from: http://news.psu.edu/story/154433/2011/10/17/research/psychologists-chase-down-sleep-demons

Prevalence. (2017). Retrieved from: http://www.thesleepparalysisproject.org/about-sleep-paralysis/prevalence/

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Creating Art: A four-week long self-study

Art is an important way to express oneself and plays a role in releasing our emotions. I spent four weeks conducting a self-study where I used art as a means of self-expression. There are three steps to this process all of which were documented weekly (each time I expressed myself artistically, the quantity of which varied from week to week. For brevity’s sake, only one instance from each week has been documented and analyzed here).

The steps are as follows:

1.) Assess and record my emotional state

2.) Paint/draw

3.) Assess and record my emotional state (post-expression).

Each of these steps was followed for each artistic experience. One final step is needed to complete this self-study and that is an analysis of each individual painting, each painting experience, and the relationship between the two; each painting chosen from the four weeks will be analyzed here.

The aim of this study is to assess the validity of art as catharsis and to understand aspects of myself that would otherwise go unnoticed.

To assess my emotional state I used the PANAS-X  (Watson,D., & Clark, L, A., 1994)[1] a psychometric tool used to measure positive and negative affect states, as well as four basic negative emotions, three basic positive emotions, and four more complex affective states. Each score has been assessed and those that are of importance for each week will be displayed (pre and post-expression) alongside an analysis of the individual piece.

The PANAS-X uses a nominal 1-5 scale to rate emotions and affect, 1 for very slightly or not at all to 5 for extremely.

Week 1: “Fragmented”

fragmented

Fragmented, self-portrait

In the week leading up to this painting I was feeling sad, lonely, and blaming myself for my feelings of despondency/loneliness. I set the environment by listening to music that reminded me of home –this generated strong feelings of sadness. I did not plan what I was going to paint; I let my creativity flow naturally influenced by my mood and the music.

“Fragmented” is a self-portrait representing how I viewed myself. I am faceless because I no longer knew who I was and I was unable to identify qualifying features of myself (how do I identify myself in relation to a city and culture I have never experienced before, and do not feel at home in). Further I have no eyes because I Was unable to determine what my future looked like, or where I was headed in this city – I am essentially blind, emotionally and mentally. I felt disconnected from myself, and a big part of that feeling stems from the relationships and connections I left behind.

The image is simple yet bold, clearly expressing my inability to identify with the city I am in, or the people in that city. Sandra Turner outlines this feeling in “Encountering what is possible – the impact of role development in facing existential crisis”: “When anything fundamentally threatens our way of being in life, the manner in which we each know ourselves, this becomes an existential threat. This threat potentially brings a loss of a way of life often coupled with a loss of the community to which we have made a commitment. We can no longer act as we normally would and this brings a loss of confidence […]” (Turner, 2002). Although Turner is referring to psychodrama and roles within psychodrama, this sentiment can be applied to my situation.

The act of creation for this piece generated a wealth of emotions – I began crying throughout the process, and found myself still crying post-painting. Staring back at the image of a faceless self I realized how fragmented I truly felt.

After creating this piece I did experience a significant emotional breakthrough, which made it easier to talk about my feelings with my significant other. I was able to understand where I was emotionally and why I was feeling this way. This helped me assess my current life situation and discuss changes I could make in my life to make my transition easier. It opened the pathway of communication about our hometown and it was comforting to know that I was not the only one experiencing these emotions. I had let my emotions completely take over my life, and being able to express how I was feeling allowed me to clear my head, see the bigger picture, and make necessary changes. Not only did the process act as a cathartic experience for me it facilitated continued emotional outlets – by communicating with friends, family and my significant other – I was able to deal more effectively with my emotions, and be more readily able to identify what I was feeling in the moment.

As we can see from the graph below a significant number of negative affects and emotions represented on the PANAS-X were typically experienced at a 1, 2 or 3, more often than at a higher rate. However, those affects that were most strongly felt were more interrelated than others recorded. An overwhelming amount of emotions were centered on dissatisfaction, anger, or blame towards the self, which influenced other significant emotions such as feelings of sadness, loneliness and being downhearted.

It would only make sense that during a time where I was concerned with feeling disconnected and estranged from my self, my friends, and my hometown, I would be experiencing feelings of sadness, dissatisfaction and loneliness more so than I would be experiencing feelings of fear, hostility and guilt. As we can see I did experience these feelings, just to a much lesser extent than the other more salient emotions outlined.

untitled

In comparison to the positive affect scale, I was feeling significantly more negative emotions. If we look at the graph below demonstrating the positive affect, we can see that for the most part my rates were ranging between 1-2, meaning there was no significant differentiation between positive affect states, but there was a significant difference between my negative and positive affect states. The negative emotions I had been feeling did have an effect on my positive emotions influencing the likelihood that I would experience them. For instance, confident, enthusiastic, and happy were all rated at a 1, which is uncharacteristic of my average affect. This indicates that my negative affect significantly influenced not only how I experienced negative emotions, but also how I experienced positive emotions. Since the strength of my negative affect was so strong this actually influenced the likelihood that I would experience positive emotions.

positive1

An important part of this experiment was measuring my affect pre and post expression and comparing the scores. Taking a look at my scores post expression I still ranked experiencing negative emotions and affect more so than positive ones, but to a slightly lower degree. Further, my positive affect increased by 1 point on affects and emotions that had been rated higher in the pre-expression assessment. However, my affect did not change for those scores that were rated lower, possibly because my negative affect was still felt relatively strongly, and possibly because feelings of joyfulness, and cheerfulness were not strongly felt prior to painting. This suggests that the artistic experience did help me emotionally, but it is hard to determine whether it was catharsis or my feelings towards the resulted image that influenced this change in affect.

positive2

These changes suggests that artistic expression does impact affect – it helped me express what I was feeling in a concrete, physical way, which helped facilitate conversation about my feelings.

The change in my negative affect can be explained by my newfound understanding of my emotional and mental state – upon completion of the piece I was able to see the whole picture. After completing the image the reason my negative mood states decreased, in particular feelings of loneliness and downheartedness, is because I was able to put into words how I was feeling and I was able to share these feelings with a confidant. As mentioned before, the painting represents a physical manifestation of my emotions in regards to my self, my relationships and my hometown. As we can see in the graph below, similar to the positive affect scale, not all affects were affected or altered.

negative2

It is of particular interest to note the changes in my feelings of anger, sadness and loneliness – because they all interact with and affect each other. Since the painting experience acted partially as catharsis I was able to express some of these feelings of loneliness and sadness in my image. Once these feelings were expressed I was able to understand them better and the source of these feelings. This of course made it easier to communicate my feelings, which further acted as catharsis.

Limitations to this process include that I cannot determine whether my emotional expression was better facilitated through the music, or if my resulting emotional state was due to painting, listening to music, or a combination of both. Regardless, this process made me introspect a great deal, focusing mainly on my negative emotional state in the previous weeks leading up to the experiment. My emotional state was significantly more potent directly prior to the expression (within 2 hours), but averaged the week prior.

 Week 2:”Floating”

floating

Floating

The process for this particular piece was in contrast to “fragmented” – I did not need music to motivate my emotions or memories, in fact, the expression was very much a result of my environment and current life events. By environment I am referring specifically to my apartment and the influence the rooms and noises outdoors had on my emotional state. The time of day, the activities I was doing at the time (drinking coffee, writing), and the sound of the street mixed with the birds reminded me of home. This made me feel very much at ease, relaxed, and tranquil, and played a significant role in my overall affect. Of course, because I was thinking of home and feeling more connected to my home I undoubtedly experienced negative emotions as well as positive ones – the difference is that the negative emotions were felt less strongly than the positive emotions. For instance, while painting I was focused more on my positive feelings: feeling proud, happy, inspired and so on, than I was on my negative emotions.

As we can see in the graph below the negative affect scale averaged a score of 1, whereas the positive affect scale averaged a 3, which translates to “moderately felt” on the PANAS-X affect scale. It is interesting to note that even though I felt positive emotions and averaged a much higher positive affect than negative, I still felt negative emotions, and these surely impacted the expression of my positive affects.

If I were to have not felt negative emotions to the minor degree that I did (for instance, while I was rating my inspiration, pride and happiness around a 3 or 4, I was simultaneously rating my feelings of loneliness and downheartedness as a 2), my positive affect would not have been affected so greatly. That is, had I rated my loneliness and downheartedness at a 1, my feelings of inspiration, happiness and so forth perhaps would have been rated between a 4-5, making my positive affect much stronger than my negative affect.

negative3

positive3

What we should also consider is how my general positive affect further influenced other aspects of my emotionality. For instance, my ratings on the self-assurance dimension were quite strong as well in comparison to the week prior, where my scores of confidence, pride and strength were around a 1. The average score for the self-assurance dimension was 2.83 (rounded up to a 3), indicating that my positive affect had a significant influence on other dimensions of positive emotions, particularly aspects of self-assurance (my feelings of inspiration and happiness influenced my feelings of confidence and strength of ability).

selfassurance

When we look at the image “floating” itself, we can see each of these positive emotions reflected. The reason this image was so easy for me to paint was because I was feeling very expressive physically, and so it was easy for me to direct that passion and energy into creating this piece. The image displays myself floating with balloons – showing a lack of gravity.

This demonstrates how I did not feel held back by anything at the time – particularly my emotions. This image represents a sense of free-floating lack of attachment – to my surroundings and to any given situation. I felt so strongly connected with my home that I was spiritually, or emotionally transported to a time and a physiological as well as psychological state reminiscent of those experienced on a similarly positive day in Ottawa. These feelings of floating were also influenced by the fact that I had received positive news, which essentially made me feel “on top of the world”, which is reflected in the image.

After the painting was complete I completed the post PANAS-X and found that the majority of my ratings did not change much from the pre PANAS-X. This can be explained by the fact that I was not experiencing negative emotions or mood states that needed to be altered or shared. Typically, when we experience negative emotions we want to return to baseline – which are neutral or positive mood states. When we experience positive mood states however, we have already achieved what we are aiming for. It makes sense then that my affect did not change much after completing the image.

The only difference between scores was found in the negative affect but was only reflected in the ratings of upset, downhearted and sad – which only changed by 1 point. The reason for these changes can be explained through reflection upon the piece. Although I was still generally in a positive mood state and experiencing feelings of pride and confidence, I was still feeling disconnected from my home and a lack of connection to my current environment. Therefore, upon reflection, I was able to ruminate more on my feelings of sadness and downheartedness in regards to missing my hometown which, generated these feelings even more.

Week 3: “Caught Between Two Worlds”

caught-between-2-worlds

Caught between two worlds

The process for this image was similar to that of floating in that it was very much a product of my emotions motivated by my current emotional state. What I had discovered at this point in my experiment is that the majority of my emotions have been centered on and influenced by my feelings towards my hometown and my strong desire to return home. I have discovered a lack of rootedness, which as Fromm declares, is one of our eight fundamental human needs (Fromm, 1941).

The image presents myself caught between Ottawa on the right, and Halifax on the left. It evokes a strangely calm and serene acceptance, an acceptance that no matter whether I remain in Halifax or return home, I will invariably be caught between both worlds. Should I return home, I would be more content because my roots will surround me, I will be comfortable, and fall back into my regularly occurring routines. However, should I return home, I will also be left with ruminating feelings of loneliness and sadness because the majority of my family will be in Halifax while I am in Ottawa –defeating the purpose of returning home. Should I remain in Halifax I will maintain the feelings of emotional stagnation but remain close with my family – which is incredibly important. My unresolved feelings towards Ottawa will keep me from growing roots in this new city.

Ottawa is painted in much more lively colours than Halifax is – the reason for this being I am much more attached to and drawn to Ottawa than I am to Halifax. The majority of my experience while in Halifax has been very emotional, leaving me feeling sad, lonely and detached much of the time. I am also quite fearful of water and being on boats, which plays into this image. I feel much more grounded in Ottawa hence the choice of parliament to represent Ottawa, whereas I feel very scared, and unsure of my surroundings while in Halifax, hence the use of water as the defining image.

All of the colours in this image work together to demonstrate my current emotional state. Although the colours draw a clear line between right and left dichotomies, and which emotion is felt for which city they are still relatively muted expressions of my feelings. This demonstrates the calmness of my sadness, loneliness and yearning. At this point in time I had been experiencing these and similar emotions and had quite some time to ruminate on them. In fact, the emotions that I had been feeling up to this point in time had essentially petered out. I am still feeling the same emotions just at slightly less intense levels. For instance, the emotions related to Ottawa and yearning to return home is still felt, and the majority of the emotions that I rate more strongly have been expressed each week. If we take a look at the graphs below we can see that I have experienced a mixture between negative and positive affect with a tendency more towards sadness than anything else.

I believe at this point my feelings of positive affect have strengthened, possibly because I have come to terms with my negative feelings. My negative and positive affects will undoubtedly continue to influence each other, but my feelings have calmed to a certain degree.

neg4pos5

As I mentioned the majority of my high ratings were found on the sadness emotion scale, similar to past weeks. Although I was still experiencing feelings of sadness and loneliness I was simultaneously rating my positive affects at more median rates, while my sadness emotions were rated at more median rates as well.

sad

This is the most interesting week so far in regards to my affect. I experienced relatively muted and mixed emotions. I experienced sadness while simultaneously feeling inspired or interested. Which leads me to believe that my emotions do generate creativity, and that by directing them into a productive outlet this facilitates further understanding of said emotions and affect states.

This piece facilitated communication between my partner and myself and I felt even more secure upon completing this image. The security I felt was linked to my desire to return home and the final decision I had made. I have come to realize that environment influences my contentedness, and that I should not be living to fulfill other peoples dreams or wishes.

What I learned throughout this experiment is that my feelings are stemming mainly from one source and are generated through thoughts attached to this source, environments that remind me of my friends, memories attached to Ottawa, and my past experiences. I discovered that I am much more rooted to Ottawa than I had previously thought.

My post expression scores on both negative and positive affect scales did not change significantly enough to graph the results and present them here. I believe that this lack of change is due to the fact that my affect was already so muted; expression in this case did not alter my emotional state much.

 

Week 4:“My Creative Mind”

mycreativemind

My Creative Mind

In the final week of my self-analysis I found that my emotional state from the previous weeks had muted significantly. In the first week of the experiment I was feeling very lonely and downhearted, in fact, I was taking these feelings out on myself and I was blaming myself for feeling such a way. I had led myself to believe that I was feeling negatively towards myself because of internal aspects instead of external aspects.

In this week the majority of my art works were expressive of my own creativity, and very much an appreciation for the evolution of my artwork. Based on the form and colour, you can see a direct change in emotionality. This image in particular is expressive of my creativity and I employed a limited number of colours. The colours that I did use were expressive of calm, contentedness and serenity. The colours elicit a feeling of general calm that has come over me throughout the four weeks. This calm is in direct relation to the resolution of my feelings of loneliness and disconnectedness felt in the first two weeks.

My brain is painted in similar colours as the surrounding image, representing a calm felt at the cerebral level— these feelings of calm emanate throughout my environment but are also felt within myself.

As we can see below my negative and positive affect scales are similar to the preceding week. I was still feeling sadness, downheartedness and loneliness but these were muted in nature. I believe that these feelings were more muted in comparison to previous weeks because I had an opportunity to deal with the underlying issues.

neg6

As we can see my general negative affect was rated quite low with the majority of scores being rated as a 1, and the remaining scores being a 2. When these scores are compared to my positive affect we can see that I was experiencing positive affect more so than negative affect and at greater intensities. Each of the positive affects were closely related to each other – that is, my feelings of inspiration were correlated with my feelings of determination, enthusiasm and strength. These scores had changed from the first two weeks because I dealt with my negative affect throughout the subsequent weeks.

pos6

For this week I felt it was important to show both my sadness emotion scale scores and my serenity emotion scale scores. My sadness emotions were rated lower than the previous weeks, but I was still experiencing feelings of downheartedness and feeling blue, which I believe is due mainly to my missing my friends and hometown.

sad2

In comparison my serenity emotion scale indicates that although I was still experiencing underlying sadness emotions, my serenity emotions were quite high. My feeling of relaxed in particular is important to note. I believe that this emotion was rated so high because although I was still dealing with negative emotions I have come to terms with why I was feeling these emotions, and I developed a plan to alleviate these feelings.

At the beginning of this experiment I was overwhelmed with my emotions and had a difficult time verbalizing the issues I was facing. Now, at the outset of this experiment I have a better understanding of my emotions and their source. This helped alleviate some stress and anxiety.

With the increase in my general positive affect and the decrease in my general negative affect I have been able to mediate my emotions, and have become much more content. Of course, just as the positive affect scale, the emotions rated on the serenity emotion scale are very much interrelated, which could explain why my scores did not differ much. Since my feelings of relaxation were so high so too were my feelings of being at ease and calm. Again, these feelings and the positive affects are interrelated, which could explain why the scores on both scales were rather similar.

serenity

The post expression scores did not differ significantly enough to display here. Although I was feeling lower levels of downheartedness and upset, these changes were not even significant enough to indicate nominally (the changes would have been between .25-.5, and the PANAS-X uses a 1-5 nominal scale). Therefore, although there was a slight difference between scores they were not significant enough to mention.

Conclusion

There is a positive relationship between my use of art as a form of expression and my affect states. Over the four weeks I came to understand my emotional state on a deeper level, and came to understand the root of the majority of my emotions/affects. In assessing my affect state both before and after artistic expression I was able to assess the potential immediate impact the expression had on my mood state. I found that for the most part my mood state did not improve significantly directly after the artistic process, rather that the act of artistic expression acted more as a facilitator for further communication and analysis. Post expression was more oriented towards analyzing the underlying emotion states and how to deal effectively with them.

This four week process was interesting for me to notice the changes in my affect and emotion states, particularly because I found myself dealing primarily with one main issue that had been effecting my mood state for quite some time. I was able to focus on this issue and explore different ways to deal with it, which led to improvements in my overall emotionality.

As an additional effect, I found that painting actually became a source of improved mood and I began seeking it out and looking forward to the opportunity to paint throughout the day. Therefore, there were three main effects: improved mood, catharsis and communication, all of which were interrelated.

Limitations

This is a self-study and therefore lacks external validity. Further, there may be confounding variables (the use of music), which may interfere with our assessment of the usefulness of artistic expression in facilitating catharsis and dealing with emotions. As a final note, this study was based entirely on introspection, which is not easily tested and not entirely reliable.

 

References:

Fromm, E. (1941). Escape from Freedom. New York, NY: Farrar & Rinehart.

Turner, S. (2002). Encountering what is possible –The Impact of Role Development in Facing Existential Crisis. ANZPA journal, vol. 11, 31-37.

Watson, D., & Clark, L, A., (1994). The PANAS-X: Manual for the Positive and Negative Affect Schedule. Retrieved from http://ir.uiowa.edu/psychology_pubs/11/

[1] Permissions to use the PANAS-X were granted me by David Watson. The PANAS-X is copyright David Watson and Lee Anna Clark (1994) at the University of Iowa.

The Power of Listening

The reason therapy works for so many is because therapists are trained to listen to their clients, and this active listening lets the client feel that they are important and what they have to say is important. When someone accesses therapy it is typically because they have something they need to communicate and have no one in their lives that will listen. This may present itself in different ways; either they have no one who is available to listen, or they feel threatened in some way by the people in their lives – perhaps what they have to say could be misconstrued as damaging to their character, or may be generally embarrassing – but they still need and are seeking help. They are seeking someone to offer an active ear and a non-judgmental, empathetic approach to their situation.

I do not believe that active listening and empathy are limited to therapeutic settings. Typically when laymen think of therapy they imagine a client lying on a couch pouring out their feelings across from a clinician expressing “how does that make you feel?” This is not how all therapy unfolds, and a lot of therapy does not have to be as structured. However, because of this conceptualization of therapy, it is believed that if there is no couch or no closed room, therapy cannot happen. This is not necessarily the case.

I have met with a number of persons who have needed counsel outside of typically identified therapeutic settings, and the same components were present – empathy, non-judgmental attitude and active listening[1]. Empathy and active listening are two very closely related actions which can be combined in order to create empathetic listening, which Burley-Allen characterizes as resisting distractions, noting and acknowledging the speaker’s verbal and non-verbal communication, and being empathetic towards the speaker’s thoughts and feelings (Burley-Allen, 1995).

image-17Interpersonal connectivity : sharing thoughts, feelings and emotions

Stewart and Logan (2002) identified three competencies in developing empathetic listening, which include focusing, encouraging and reflection. All three competencies work together to encourage the speaker to communicate their feelings, issues and desires. It also allows the speaker to feel more at ease while discussing their thoughts. Ender and Newton (2000) demonstrate the importance of paraphrasing the thought and feeling of what the speaker has said in a non-evaluative way, while still interpreting their understanding accurately. This is important because we do not wish to make the speaker feel uncomfortable, or uneasy. We want the speaker to feel able to express him or herself free of judgment, so we must take care to withhold judgment from both thoughts and feelings. This is directly linked to empathetic understanding, which as we know, is the understanding of the clients’ views and experiences from their frame of reference (Ender and Newton, 2000). Cuny, Wilde and Stevens (2012) point out that through empathetic listening and understanding we can help the client/speaker develop personal understanding. Empathetic listening can be used to promote communication, develop cognition and enhance self-concept. Empathetic listening and understanding also promotes a specific attitude which translates to the client as them having worth, and something to offer, which helps develop self-confidence (Cuny, Wilde, & Stevens, 2012).

Stanley Jackson states that “the psychological healer, in particular, is one who listens in order to learn and to understand; and, from the fruits of this listening, he or she develops the basis for reassuring, advising, consoling, comforting, interpreting, explaining or otherwise intervening” (Jackson, 1999). This demonstrates the importance of listening for the counselor, outside of building trust and offering a cathartic experience for the client. Of course, listening is important in assisting the client through catharsis, building trust between client and counselor, and aiding in self-development, esteem and efficacy; but it is also important in understanding the client and situation better. We are unable to help a client without first knowing, and understanding, what it is they need help with. It is true, that listening in and of itself is powerful in facilitating healing for the client; but we must be able to provide further assistance after the fact, through proper application of interventions or therapies.

The most relevant person to mention while discussing the power of listening is of course, Carl Rogers, who championed empathic listening in his client-centered therapy. Rogers identifies the value of empathy in a multitude of ways. First he states that empathy indicates to the recipient that someone cares for, accepts and values who he is as a person (Rogers, 1975). He states that empathy “dissolves alienation.” That is, it breaks down barriers between person and therapist (Rogers, 1975). The analysand in question is requiring attention and care, possibly for issues that may arouse judgment or isolation. Through our use of empathy we no longer see alienation as an option, and we allow the clients to fully express themselves, to fully experience the all too needed catharsis. This of course, leads to better therapeutic results.

There cannot be active listening without empathic understanding; the two go hand in hand, and work in conjunction with each other. By understanding a person more fully through our listening, we pave the way for the client to understand himself in a full or complete way without inhibitions (Rogers, 1975). Rogers indicates that by our full understanding of the client we offer them a way to understand their self, which facilitates congruence (Rogers, 1975).

Rogers and Farson (1987) show that people who are listened to in such an active and sensitive way learn to apply such methods to themselves, and listen with more care and are able to vocalize more precisely how they are feeling and what they are thinking. They identify that there are two essential components to what a speaker is saying; there is the content of the message, and the feeling or attitude, which underlies the content. Both are equally important and must be attended to in order to understand the complete picture, (Rogers, C., & Farson, R., 1987). There are a few ways that we as listeners may attend to these underlying messages: firstly, we must consider the emotions, and respond to the feelings conveyed by the speaker. By our responding to the feelings we acknowledge the speakers emotional state, and offer a space where they may feel safe and able to express themselves. Secondly, we must note all cues; facial expression, verbal cues such as inflection, speech style, and body language. All of these things may work together to let us know more of what the speaker is trying to convey. For instance, a client may wish to express they are feeling hurt, but may fear reprisal and so they may try to mask these feelings. It is our job as listeners to study their body language, facial expressions and tone, all of which may help indicate the underlying emotion the client may be shying away from expressing. In this way, we may respond not only to the content, but also to the underlying emotion, which truly shows the client that we are listening and that we care.

Active listening is an important component of any therapeutic scenario, and can be employed in every interaction with another person. It demonstrates respect, builds trust, and facilitates a relationship between speaker and listener. It tells the speaker that they are valued, and it encourages them to value themselves.

Many consider listening as a passive component in therapy, when in fact it is the most significant component in any therapeutic scenario without which we would not have an understanding of the other person. Listening is a powerful tool, and truly listening leads us to develop healthier, stronger relationships with our clients, and leads our clients to better understand themselves and relationship dynamics. Listening is an all too important tool that we can apply to every scenario, and offer our clients when we find ourselves with nothing but our attentive ears to give.

 

[1] Therapy cannot occur without a licensed practitioner, just the same as art therapy cannot occur without a licensed art therapist. However, we can employ therapeutic methods while counselling our clients in atypical settings (within their homes, at school, on the street).

 

References

Burley-Allen, M. (1995). Listening: The forgotten skill: A self-teaching guide (2nd ed.) New York, NU: John Wiley & Sons, Inc.

Cuny, K, M., Wilde, S, M., & Stevens, A, V. (2012). Using Empathetic Listening to Build Relationships at the Center. In. Yook, E, L. & Atkins-Sayre, W. (Eds.), Communication Centers and Oral Communication Programs in Higher Education. UK: Lexington Books.

Ender, S, C., & Newton, F, B. (2000). Students Helping Students: A guide for peer educators on college campuses. San Fransisco, CA: Jossey-Bass.

Jackons, S, W. (1999). Care of the Psyche: A history of Psychological Healing, New Haven & London: Yale University Press.

Rogers, Carl. (1975). Empathic: An Unappreciated Way of Being. The Counseling Psychologist. Vol. 5, No. 2-10.

Rogers, C., & Farson, R. (1987). Active Listening. From Communicating in Business Today R.G. Newman, M.A. Danzinger, M. Cohen (eds) D.C. Heath & Company.

Stewart, J., & Logan, C. (2002) Empathetic and dialogic listening. In J. S. Stewart (Ed.), Bridges, not walls: A book about Interpersonal communication. (8th ed., pp. 208-229) Boston, MA: McGraw-Hill.

 

How We See Art Helps Explain Our Psyche

In our assessment of art as a creative, emotional and psychic expression, we can understand its nature to be based almost entirely on the innermost workings of our personal psyche. Art, just as dreams, can be completely meaningless, simply a mixture of nonsensical images, colours and lines. However, upon further analysis these may represent archetypes, unconscious and internalized problems, or act as a mode of wish fulfillment. As an onlooker, we are unable to fully understand the meaning behind an individual’s artistic expression – in fact we analyze it in such a way that we ascribe our own unconscious feelings and conflicts onto the image. Jung illustrates this in Modern Man in Search of a Soul when he says: “whatever we look at, and however we look at it, we see only through our own eyes” (Jung, 1933). This portrays that although there may be multiple interpretations of a particular image, our analysis of the image will assuredly express more an aspect of ourselves than any aspect of the artist.

Jung summarizes archetypes and their meanings in his book “The Archetypes and the Collective Unconscious” (Jung, 1969) and though these may assist in our initial assessments we should not rely on them to get at the core of the image. Just as what we see in an inkblot helps determine our internal processes, so to does our assessment of another person’s art. Therefore we should allow for projection in our interpretations. Through this projection of our self in the assessment, we can be led to understand ourselves more through the viewing, and analyzing of others art. What we assess as an artists motives, are more closely our motives.

This is not to say that in our assessment we may not get at, to some degree, a better understanding of the artists personal motives (for by chance or human nature, we may share the same or similar motives as the artist under analysis. In fact, if we are to follow suit with the idea of the collective unconscious and our understanding of archetypes presented by Jung, it is not too far off to say that our assessment, although I am speculating it will mainly be our own self projected onto the piece, will in fact have some element of truth to it). We will not be able to determine what an image is expressing without asking the artist himself. Even then, we may be at an impasse, because our question may be met with trepidation. Perhaps the artist has created a most intimate piece illustrating his inability to fulfill his self in any realm of his existence – and this is embarrassing to express. An alternative scenario; the image in fact, means absolutely nothing. It is absolute nonsense, and this too, is embarrassing to express. We hold our artists in absolute reverence, we put them on a pedestal and see them as higher beings with greater insight and understanding of the human psyche – they are more in tune with themselves, with nature, with their fellow man. Why then, would an image an artist create mean absolutely nothing? We automatically feel the need to ascribe meaning to an image. In fact, even in its nothingness, we still find meaning – “artist A created an image of lines and boxes, circles and splashes of paint. He indicated that it means absolutely nothing, with that we can deduce that he feels that he is absolutely nothing and life has no meaning.” These statements are not entirely erroneous, but they are unfounded. They are based entirely on speculation.

A pressing issue we need to address in regards to interviewing the artist about the meaning behind the image is that introspection is not entirely scientific. Although Wundt demonstrated its importance through his voluntarism (Wundt, 1894), it lacks reliability and we are unable to measure or quantify it. If we consider the scenarios above, although the artist is of course, capable of introspection, he can very easily modify what he finds in his psyche. That is, we may ask “what does this image mean” and he may be embarrassed to share the truth, therefore, he may alter the truth and we may receive an inaccurate understanding of the image. Therefore we should not focus on understanding what the image means from the artists eyes, but instead we should allow our analysis to help us better understand our own psyche, through the projections we make in our analysis.

Though archetypal images may suffice to supplement our depiction of the images we should not rely too heavily on them, and in the process of analyzing images we should use them solely as motivating forces. If we rely too heavily on them we will be faced with resistance. When we are met with resistance surely this indicates that what we have uncovered is not only true of the image, but also true of our selves. Though we may be encouraged to protect our egos through this resistance, we should not work against it. In fact our resistance indicates that we have uncovered a truth about our selves previously unknown. This truth may frighten us to some degree, hence we will respond with resistance. Resisting the truth will not result in a protected ego, as we are wont to believe; in fact, it will result in a fragmented, damaged, and fearful ego. Fearful of what we are aiming at discovering – our true self.

It is easier then for us to determine the meaning behind an image using an archetype because we can separate our self from the interpretation. There is no aspect of our psyche in an interpretation that relies solely on archetypes.

How then, should our interpretation follow if we are to focus our attention mainly on our unconscious psyche? This interpretation would be similar to our assessment of a Rorschach inkblot; assuredly, our interpretation of art can be used as a projective measure involving Freudian free-association. To the reader who is confused in the importance of our allowing these deep, potentially dark truths being revealed to us through our interpretations, the answer is simple. We uncover these truths so that we may face them and deal with them. We uncover these truths so that we may consolidate them into the whole of our being, in order to actualize and find congruence between all the selves –the perceived, real and ideal.

As humans we use art to express ourselves and to connect with others, and for this reason it is one of, if not the most, important ways we can understand the self.

Let us take for an example one piece of art along with my interpretation of said piece of art. I have provided my affect state and preoccupations prior to my interpretation so as to provide a reference point for my interpretation.

I have also provided a previous interpretation I have made on the same piece of art in order to compare the two interpretations, and determine the extent to which my affect and preoccupations have had on the interpretation.

Current affect/general feeling:

  • Proud (of what I have achieved in the past few weeks)
  • Confident
  • Content
  • Reserved
  • Insecure

Current preoccupations:

  • Self image
  • Others perceptions of myself and body
  • The change of seasons
  • Creativity and being successful through my creativity (recognition from others, acceptance from others based on my artistic abilities, being recognized as artistic and creative)untitledSalvador Dali “Dream caused by the flight of a bee around a pomegranate a second before awakening”

The image above is by Salvador Dali, and I have interpreted this image before, nearly a year ago. The main focus of the image is a nude female figure prostrated on the stone floor exposing her self, seemingly proudly. Her form seems to be based off of an ideal figure, and the gaze is very focused on her body rather than on her face. The soul can be found through looking into someone’s eyes, which demonstrates to me the potential that this woman is idolized as the perfect female figure, without her internal aspects being taken into consideration.

On the other hand, if we look at this from a female perspective, we are able to understand the image more so as a woman being proud of herself, (we could still apply the same understanding of the soul here, and say perhaps that she is proud of what society has told her to be proud of, namely, her body, while shunning “unfeminine” aspects of herself – her mind, her creativity, her self).

If we look closely we can see there is a rifle pointed at her face. Perhaps this is a “shaming” her for being so expressly proud of her self, and failing to be modest. The tigers fall in line with this understanding as well, and can be seen as an extension of the rifle. They are leaping towards the woman in a rather aggressive fashion – their mouths agape. This could represent another form of shunning – telling women how to behave, how to dress, how to demonstrate her pride (or to not do so).

What is interesting to note however, is that the focus is still on the woman –regardless of whether other aspects of the image are pointededly demeaning her for her confidence, pride, and immodesty. This to me indicates that although women are told on various occasions in various different ways how to behave or how to feel about their bodies and minds, they still continue to persevere, and are able to determine if they will be proud, and how they will express said pride. There is a constant battle between woman and societal demands indicating what is and what is not “feminine.”

My previous interpretation was made August of 2015, and can be found below.

My initial interpretation was made from a Freudian perspective; that is, I assumed the guise of Freud, and my interpretation followed in suit of his dream analysis approach. Therefore, there was none of my own psyche being reflected onto the image.

The image is riddled with sexual desire and motivation. The woman is prostrated on a rock exposing herself to the oncoming tigers (representing men); begging to be devoured. The fact that tigers represent men here demonstrates their animalistic tendencies and their express interest in the female figure represents the carnal urge of eros. We must also pay close attention to the pomegranate from which the tigers are springing. The pomegranate is a representation of the female womb; the female womb bears fruit, that is, provides life. Here then, we can see a life cycle in action; men come from women, and spring to women following their carnal urges, in order to perpetuate the cycle. Similarly, the fish too, often represents the woman.

The atmosphere of the image as a whole supports this idea of sexual reproduction. The main focus in the background of the image is the body of water which is a life force, a source of baptismal renewal, rebirth. Water is found to be necessary in every instance of life – we as humans need it to survive, as do animals and plants.

Further, the rifle could be seen in two ways: holding the female figure hostage against the male advances, or, as shaming the female figure for submitting to male advances. Should we consider this from a modern societal perspective, we can see how true the latter is. Women tend to be held hostage in their own bodies: they are met with a plethora of demands – demanding them to be sexual beings while simultaneously maintaining their modesty (because their worth is linked very strongly to their chastity). Therefore, in this image the woman is simultaneously submitting to the male desire and being shamed for it.

The reason I am not providing an affect scale or preoccupations for this final interpretation is because it was completed from a Freudian perspective, therefore it was not influenced by my personal experience.

If we look at the first interpretation provided and compare it with the affect scale provided, we can see just how related they are. At the time I mentioned feeling quite preoccupied with my personal worth, based predominantly on my physical appearance and how others perceived me. In my interpretation of the image I focused on the female figure and her exposing herself to the viewers (namely society). Further, I found it easy to associate her turning her face away from us as viewers as a demeaning of her cognitive, internal functions (her intelligence, soul, creativity). As we can see, I mentioned I was preoccupied with my own creativity – being creative while obtaining appreciation and acknowledgement for my creativity and ability.

In this instance then I was seeking said appreciation and acknowledgement (hence the audience of tigers ascribed in the image). Tigers are a wild animal characterized as vicious therefore it makes sense that I would interpret these tigers as society (society being any onlooker, not necessarily society as a whole. It has an additional connotation). Although I am seeking validation (validation of my appearance, acceptance as an aesthetically pleasing being, as well as validation in my creativity), I am simultaneously trying to survive without it. I acknowledge my want to express myself freely, to accept myself (the inner and outer aspects of my self) without relying on the approval of others while waiting for said approval; hence the female figure prostrated on the rock for all to see (and be judged and shamed for her exposing herself both physically and psychically). There is a dichotomy in the interpretation, as well as in my preoccupations and affect states (as is normal for us as humans to experience.)

For instance, my affect states were noted as content and confident (in my creative abilities, and the past successes I had made) but also referring to my body and aesthetic. I, as many women, struggle with accepting my body and with seeing myself as “beautiful” or worth recognizing as such. Typically my feelings of self-worth fluctuate, as does my confidence in myself as an aesthetically appealing person. It is interesting to note that my confidence in my internal abilities fluctuates, but not as often as my confidence in my external qualities. It makes sense then that I should not only be focusing mainly on the external aspects of the female in this image, but too that my affect state of confidence/contentedness would be juxtaposed with reservation and insecurity. In fact, this is relatively normal for me. Although I may feel confident with myself, there tends to be an underlying feeling of insecurity in my body. I mention too that the female figure seems to be idealized; perhaps unconsciously I was comparing myself to the image of the female figure already calling into question my current confidence.

As we can see, my interpretation of Dali’s image falls closely in line with my current preoccupations and affect states. Does this indicate that my hypothesis is correct, and that we should be right in assuming that our personal interpretations of art may uncover unconscious aspects of our psyche? Perhaps, but as mentioned before, we cannot conclude with any certainty that this is correct, because these speculations are relying very strongly on introspection. Introspection is helpful, but as already mentioned, cannot be quantified, and therefore cannot be scientifically studied. This is not to say that we should not be using art interpretation as a way of understanding others and ourselves.

Consider our dreams, which Freud determined were manifestations of our wishes and desires (typically of an erotic nature). These help us to understand aspects of our selves that may be buried within our unconscious, and through interpretation may come to light so that we may incorporate them positively into our self. The same can be said of our interpretations of artistic pieces (they, like dreams, are comprised of symbols, archetypes, images that denote specific meaning). There are a plethora of different meanings we can ascribe to an individual image, just as we can ascribe to a dream image, or a poem. Found within the meaning we ascribe to the image are aspects of our unconscious, aspects of our psyche that may have not been fully consolidated into our self – bring them to consciousness and we may incorporate them into our self, or should they be of an entirely neurotic nature; deal with them appropriately.

Just as the Rorschach inkblot test acts as a projective measure, our interpretations of artistic images can act in the same manner, providing us with another venue for understanding our self and coming closer to actualization.

 

References:

Dali, S. (1944). Dream Caused by the Flight of a Bee Around a Pomegranate a Second Before Awakening [Painting]. Retrieved from http://www.dalipaintings.net/dream-caused-by-the-flight-of-a-bee-around-a-pomegranate-one-second-before-awakening.jsp

Jung, C. G. (1933). Modern Man in Search of a Soul. New York: Harvest. p. translators’ preface

Jung, C.G. (1969). Archetypes and the Collective Unconscious [sic], Collected Works of C.G. Jung, Volume 9 (Part 1), Princeton, N.J.: Princeton University Press.

Wundt, W. (1897). Outlines in Psychology. Trans. Charles Hubbard Judd. Leipzig, Germany.