Art and recovery style from psychosis

The concepts of integration and sealing-over as recover styles from acute psychosis are common clinical parlance. Our experience with acute schizophrenic patients has led to specific operational definitions and a scale which can reliably assign patients to these two categories. All acutely schizophrenic patients on an NIH Clinical Center research ward participated in individual art sessions during drug-free periods at admission, at discharge, and at 1-year follow-up. In each session, the patient drew: a) a picture of his choice; b) a self-portrat; and c) a picture of his psychiatric illness. We hypothesized that integrators would pictorially represent themselves and their illness with greater expression, ideational fullness, and affective force than patients who sealed-over. Twenty-four patients were divided equally into integrator and sealing-over groups (based upon ratings at follow-up) and matched for age, sex, and race. Their art productions were presented randomly to two independent raters unfamiliar with the patients. They scored pictures quantitatively for color, motion, detail, empty space, and global expressiveness. Inter-rater reliability was satisfactory. A mean rating was obtained for all pictures from each patient on each of the five art variables. Paired t-tests (two-tailed) were applied to contrast the two groups on each of the five art variables. The results were that the integrators used more color (p less than .05), drew with greater detail (p less than .01), and more globally more expressive (p less than .05). Integrators also tended to depict more motion (p less than .10), but were not different from the sealing-over patients in amount of space left empty. These results support the validity of integration and sealing-over as defined and support the use of art as a medium through which differences in individual styles of coping with the psychosis can be discriminated. Slides of the patients' artwork illustrate the findings.