Vocabularies of Silence: On Psychosis and Language

Guest Post by Sasha Durakov Warren

Sasha Durakov Warren is a writer, former psychiatric service user, and current mental health worker based in Minneapolis, USA. His first book, “Storming Bedlam: Madness, Utopia, and Revolt,” on the history of psychiatry and radical politics was released in March 2024 with Common Notions Press. He also helped to co-found a Twin Cities Hearing Voices group, and the Minnesota chapter of the International Society for Social and Psychological Approaches to Psychosis (ISPS-US). He writes about psychiatry, political economy, history, and aesthetics on his Substack “Of Unsound Mind.”

Through a re-reading of historical movements, Warren argues in Storming Bedlam: Madness, Utopia, and Revolt that long standing divisions between social and biological approaches or between psychiatry and anti-psychiatry as discrete positions are tenuous and circular. Instead of avoiding these binaries, Warren travels through them, using their own internal logics to expose their hidden presuppositions in search of an approach to mental health care grounded in common struggles against conditions of scarcity, poverty, isolation, and exploitation.

Pre-text intro by Sasha Warren:

I am very grateful to have been invited to contribute a post to Awais Aftab’s Psychiatry at the Margins, which I view as one of the most intellectually stimulating, challenging, and approachable websites on the topic. I formerly sought out Awais for a blurb for my book Storming Bedlam, because his work and the work he hosts pushes me to face inconvenient holes in my reasoning and outlines ethical conundrums I hadn’t been able to formulate. Even when one disagrees with such a person, rigorous, challenging writing is a gift to anyone who values living thought over the inertia of assumption. Awais asked me if I wanted to write something introducing my book for this newsletter. Though the following text does not discuss Storming Bedlam directly, it is intended to function as a standalone piece of writing as well as an introduction to a major theme of chapter two, namely the mediating role of language in various approaches to psychosis. This guest post will be succeeded by the publication of a follow-up post, a mini-Q&A with Awais, in which I offer further clarification on what I mean by the language of psychosis and its translation in the clinical context.

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Vocabularies of Silence: On Psychosis and Language

Many fundamental psychiatric concepts rely directly on a theory of language and communication. But beyond this, language mediates all psychiatric encounters at multiple levels. The psychiatrist and patient need to be able to communicate with one-another for diagnostics, to track progress or to exchange feedback about a treatment, or for innumerable other interactions. 

What exactly is language and why does it matter? Some readers may feel that because they talk to people every day and seem to understand each other perfectly fine, or because they can recognize nonsense when they hear it, these questions are trivial. 

It’s my contention that different models of language facilitate different possibilities in the clinic. If we assume that madness is defined by an incapacity to communicate or reason, as 17^th and 18^th century proto-psychiatrists did, then the best outcome we can hope for is a passable imitation of speech. Since the patient could not possibly understand anything, rehabilitation was out of the question, so the physicians turned towards “domesticating” individuals with madness, often with gratuitous violence. Beginning with moral treatment, the linguistic assumption in psychiatry changed. It was believed that mad people retained a “fragment” of reason discernible in speech. I trace the evolution of this assumption from Philippe Pinel to Sigmund Freud to Karl Jaspers and briefly examine the split between models focused on identifying biological urges and those that used increasingly complex interpretive methods. Though these models can be impressive, I argue that Walter Benjamin’s theories of expression and language open the door to more felicitous and open-ended encounters with psychosis than denotative models seeking mere facts. I will conclude the discussion with a practical example of such a model in Nise da Silveira’s art therapy programs.

Art by Adelina Gomes (source). She began painting in 1946 at the Occupational Therapy Section of the Painting and Modeling Studio when psychiatrist Nise da Silveira took over the supervision of that section at the psychiatric center of Pedro II Hospital. During this period, Adelina was undergoing treatment for schizophrenia. (wikipedia)

Domestication and Language

In the 17^th and 18^th centuries, in countries like England, France, and the US where psychiatry was beginning to flourish, the mad were often depicted and treated as animals. Why animals? Firstly, because of their supposed physical attributes while furious and raving. Madness was identified symbolically with the figure of the “furious maniac,” who was compared to an animal or a “brute.” This view held that animals lacked the sensitive organs that perceive, or remember and interpret pain. Secondly, the mad were compared with animals because of their apparent lack of reason. Blaise Pascal illustrated this logic in Pensées when he wrote, “I can certainly imagine a man without hands, feet, or head, for it is only experience that teaches us that the head is more necessary than the feet. But I cannot imagine a man without thought; he would be a stone or an animal.”¹ Reason is the exclusive province of human beings, and to lose access to rational thought and the capacity to communicate these thoughts is to sink into the mutism of the animal kingdom. 

The relationship between psychiatric determinations and communication is obvious for those conditions that directly refer to the ability to speak like aphasia or catatonia, but it’s equally true that a psychiatrist could not explain what they mean by “psychosis” or “delusion” without reference to the patient’s form of expression. This may not be immediately obvious, for psychiatrists have historically been more likely to center “reason” rather than disordered expression in their definitions of madness. For example, John Haslam, the apothecary of Bethlem Hospital in the beginning of the 19th century, wrote that “Madness being the opposite to reason and good sense, as light is to darkness, straight to crooked [...] a person cannot correctly be said to be in his senses and out of his senses at the same time.”² But how is this “reason” to be discovered? How do the parties ascertain who is right and who is disordered except through language? 

In this conception of reason, even if a person enunciates sounds and articulates words, they are effectively, that is, treated as mute if their speech does not conform to reason. Every conception of reason must have a subject who expresses that reason whether in writings, speeches, or by some other means; therefore all models of “reasonableness” are themselves or presuppose models of communication. When Haslam wrote that the question of delusion is a simple matter of figuring out who is right or wrong in an essentially juridical sense, his claim relies on a notion of language as the mere transmission of facts. Haslam’s model of language is wholly denotative: it involves thinking of an idea or a notion and saying it to the other who receives it as intended. He does not for a moment wonder whether another associative principle or path to meaning making might exist. The notion that his patients speak in metaphor, for example, simply does not occur to him.

Putting aside the debasement of animal life and insensitivity to animal pain, for the 17th century physicians, the identification of the mad with the animal legitimated a whole range of domesticating techniques of enormous violence: whipping, chaining to walls, exposure to frigid temperatures, excessive bleeding, or freezing water baths. A dominant idea, given voice by Thomas Blakewell, was to shock and frighten the person into a state of submission: “Language and actions [were once more to] become subordinate to a well-regulated will.”³ How? By first subordinating the human animal to an external will through extensive use of external restraints and force and then cultivating this power within the madman himself. Whether the mad person in question became reasonable or sane by means of this power was an open question, but most practitioners were pessimistic, believing that at best they could be domesticated, like a dog, rather than socialized. Imitation, or, in clinical terms, echolalia, was ultimately deemed preferable to letting dangerous mad people rave in wild abandon. 

The Fragment of Reason

All this changed with the advent of moral treatment and the birth of modern psychiatry at the end of the 18th century. For psychiatrists like Phillipe Pinel, Jean-Étienne Dominique Esquirol, and William Tuke, the mad retain a “fragment” of reason. No one’s reason is ever fully destroyed, they argued, but it becomes confused or diminished and needs coaxing and attention to return to its full capacity. Putting aside external circumstances determining these changes, the practice of moral treatment involved centering the simple acts of active listening, intensive and patient observation, and dialogue between patient and physician. Pinel and Esquirol discovered something that was always there: their asylum inmates were not superhuman brutes who paid no mind to intense pain and deprivation, they communicated constantly, and they had the capacity to reason, however subjective their rationality may appear. That so few physicians noted these quite obvious facts speaks to the overwhelming inertia of professional pressure, the needs of the institution, and presupposed belief. 

Psychoanalysis took the next major step in this direction when Sigmund Freud posited a fluid spectrum between psychopathology and “normality.” Freud’s talk treatment made it entirely clear that language is the privileged gateway to psychic phenomenon. It is of great importance in this respect that so many of Freud’s examples in The Psychopathology of Everyday Life involve problems in language: slips of the tongue, everyday forgetfulness in conversation, or issues with reading and writing. To be clear, for Freud and other theorists I will discuss later, language is not equivalent to verbal enunciation: “‘speech,’” he wrote, “must be understood not merely to mean the expression of thought in words but to include the speech of gesture and every other method, such, for instance, as writing, by which mental activity can be expressed.”⁴ It is only by being attentive to language that we gain access to the psyche and its conflicts. If, as Lacan would say later, the unconscious is structured like a language, it should come as no surprise that we become aware of unconscious phenomena through linguistic expression.

At the same time, Freud had self-acknowledged shortcomings when it came to long-term therapeutic relationships with people experiencing psychosis. His only sustained encounter with a psychotic case, the Schreber case, had its moments of brilliance like when he recognizes that the phenomenon we refer to as “delusion” is not the illness in itself, but the mind’s attempt to reconstruct itself from a fracture or trauma. And yet, Freud’s analysis documents a failure to sustain a real dialogue with and quite possibly a professional fear of psychosis: Schreber was alive and living in an asylum in Germany, but Freud based his entire analysis on a single text written by Schreber, and made no attempt to meet or establish further contact before making a rather hasty diagnosis of familial-sexual problems and interpreting Schreber’s book through this lens.

Nevertheless, intensive explicit interest in the language and communicative strategies of psychosis began around this time, at the turn of the 19th and 20th centuries, very often in response to the theories of Freud. The great advances made in this period can be attributed to the fact that these 20th century thinkers directly addressed and treated what was before usually presupposed. One can, without too much distortion, divide the dominant theories of language in psychiatry into two broad areas of interest: 1) vitalist and biological theories of urges or drives and 2) theories of interpretation and understanding. The first set can be represented as a spectrum ranging from theories around innate or inherent biological-instinctual urges and instincts (e.g. the need to eat, sleep, procreate, etc.) to drives imminent to a psychic structure determined and constrained as much by the biological features of humanity as culture, history, and linguistic factors (Freud is closer to this pole).

The Urge

Some of the most important figures for the theory of urges are Carl Jung, Ludwig Klages, and Hans Prinzhorn. Prinzhorn, an early collector of psychiatric patient art, was convinced there were a number of “urges” that survive in even the most extreme psychic illness. Of these, the urge to express oneself, which he described as governed by the need to “actualize the psyche and thereby build a bridge from the self to others”⁵ is the most universal. But why do these forms of expression exhibit any common formal elements? Theorists of urges like Prinzhorn and Cesare Lombroso responded to this question by positing systems of urges of varying complexity built atop the basic urge to communicate: there might be an urge towards formalism, an urge towards geometry, and an urge toward symbolic expression. 

Carl Jung was the primary theorist of the most complicated of these: the urge to express oneself via symbols. Thanks to his work with psychotic patients under Eugen Bleuler in Zurich, Carl Jung was much more comfortable working with and theorizing about psychosis than Freud. The Jungian school has proven far more influential than Freud’s work on the question of psychosis thanks to his extensive familiarity with the topic. According to Jung, people’s specific ideas and concepts draw from a stockpile of archetypal symbols. These are not singular symbols with a well-defined figural shape like Orpheus descending into Hades, but rather formal possibilities inherent to the unconscious, like the motif of death as a descent. The motif can take many shapes, but the basic structure of the motif remains the same. 

Whether one accepts that we all have access to primordial forms and symbols, that we contain within us inherent biological or psychic urges or needs, or that even the most confused speech can be subject to various forms of interpretation, these theories opened up new vistas for communicating with psychosis, for “reading” it in the clinic. Unlike physicians in the 18th century who only rarely took any interest in the artistic productions or speech of their patients, psychiatrists who believed in an inherent need to communicate saw a yearning to connect in their patients’ words and art. Alternatively, one could read a crude drawing by a patient by searching for archetypal forms like a mandala and compare their treatment of the symbol to past examples in mythology. Finally, one could pick up the paper and turn it around looking for evidence of psycho-motor dysfunction, symbolic meanings related to their personal life, formal characteristics that tell us something about their state of mind (e.g. wild scribbles could point to a state of excitement). At the same time, these theories tend to agree that there is something “low” about the communicative strategies of patients, as if there was a linear progression of language from low complexity to high. Not totally unlike their predecessors, 20th century psychiatry, especially prior to Naziism, continued to class psychiatric patients with children, so-called “primitive people,” and sometimes even animals. They just asserted that these groups were not separate from humanity, but rather the lowest functioning form of it. 

Even the 20th century psychiatric theories of language tend to take too much for granted and bypass the basics. To go back to the basics is not at all to claim that theories of language are “neutral” or have no bearing on practice. What must be stated emphatically here is that while theories of language are hypotheses, they have enormous consequences for psychiatric determinations and treatment as the above examples comparing the representation of patients as animals as opposed to communicating (though very low-functioning) human beings show. The issue is instead that most of the previous authors seeking to understand the language of psychosis begin with an institutional necessity and presumption (e.g. “I am faced with a disordered person who needs some form of treatment”) and shape a theory of language around this need, sometimes picking and choosing from different theories until they produce something with some value in their clinical environment. This is an instrumental use of theory, which sacrifices the quest for coherence to pragmatic concerns. Paradoxically, this facilitates an impoverishment of both theory and clinical practice.

Mad Speech as a Manifold Phenomenon

At the most basic level of generality, all the theories I’ve introduced so far share an instrumental understanding of language as the vehicle for the transmission of mental content. Karl Jaspers deserves credit for making this explicit, for outlining the most thorough linguistic theory of understanding, and for clearly differentiating between the different elements at play. 

Language, he writes, is composed of a number of components without which it can’t exist, but which cannot represent the whole of language. There is “pure utterance,” that is, sounds like cries, screams, or whistles. There is speech, which is composed of articulated words with specific meanings. Both of these are to be differentiated from “expressive movements,” which are closest to what we call “body language.” Much of this is involuntary and includes things like twitches of the eye or lip or blushing of the face. Only speech is the proper realm of language and is composed of a “system of symbols, sanctioned by traditional usage, and used as a tool by anyone who grows up within the system.”⁶ Language, therefore, is an instrument for communicating thoughts constrained by the limits of a socially determined system of symbols. In other words, language appears as a circumscribed means to the end of transmitting meaning. That meaning lies outside the language, since language merely carries it from one place (inside my thoughts) to somewhere else (to another’s thoughts). We can place Karl Jaspers on the side of overdetermination, meaning here that the confused speech of someone in psychosis could equally be caused by a number of factors that could occur simultaneously like organic-neurological speech disorders, a significant personal trauma, cultural or linguistic differences between the speaker and listener, or the confusion of modes of interpretation (e.g. a patient speaks about their theological or existential beliefs, which are read as representations of concrete material reality).

This provides a seemingly objective criterion for judging the language of psychiatric patients: one can differentiate deficiencies of the instrument (stuttering or aphasia, which occur on the level of the utterance) from disorders of symbolic structure (psychosis proper). In the latter, we come up against what Jaspers terms the “ununderstandable.” Understanding, he says, can only occur when what is to be understood is “fully expressed in some movement, utterance or act.”⁷ Jaspers was far more sophisticated in his approach than Haslam, and broke up the understanding into a number of interrelated approaches extending far beyond the mere apprehension of material facts. We can think about a statement in the context of the patients’ experience or bodily expression, we can try and grasp a motive, we can pay attention to the direct cause of a statement, we can try to discern an inner logic between statements (even if we cannot empathize), and we can contextualize speech in cultural practices or religious systems. Understanding understood in this way constantly hits limits, but explanation, what Jaspers calls “the discovery of causes,”⁸ is theoretically unlimited. 

All objective data are incomplete and depend on acts of interpretation, when “sparse clues allow us to apply with a reasonable degree of probability certain meaningful connections that we have come to understand from elsewhere.”⁹ Let’s say a patient says “I speak the language of rays.” 1) We can approach this statement through phenomenological study of its expression, that is, using observation and self-description to arrive at an idea of the person’s experience. If they said this while outside and staring at the sun while making gestures with their arms towards it, we can make all sorts of inferences and deductions about the nature of their experience. 2) We can try to grasp the causality of a statement in a definite psychic economy. In this case, perhaps this patient said on another occasion that God is the master of rays and sends rays to earth. This might be odd, but now the statement fits within a metaphysical or theological structure we can conceptualize and engage with. 3) We can likewise seek to understand such a statement through cultural, familial, biographical, or sexual factors. Perhaps this person comes from a religious tradition that places great emphasis on the sun or has previously identified the sun as a symbol of sexual fertility. The ununderstandable then is not an absolute for Jaspers; it is the limit faced by an understanding that can only assess statements according to past experience within these categories. Attempts to understand will always meet limits, but these are “a fresh stimulus to formulate the problem of cause anew” that drive us to discover more possible connections rather than an unsurpassable abyss. Still, as soon as we pass such a line, it recedes once more into a limitless horizon as we meet a new set of problems. This is to say nothing of the patient’s “judgment,” the faculty proper to delusion for Jaspers, but only of how we can understand or interpret their mode of expression.¹⁰

If language is a means, or a tool, for communicating mental content, we must ask: what is the mental content it expresses prior to its expression in language? In what pure, ethereal realm are ideas and notions supposed to exist prior to taking shape in language? How can the representation of things to ourselves within our mind as mental content exist without the form of language? When thought through to its conclusion, the theory of language as a means of communicating preexisting ideas relies on a metaphysical flight of fancy, in which the human mind appears as a kind of infinite workshop of formless matter waiting to take comprehensible shape as words and sentences by a subject that desires to express this shapeless content. 

Linguistic Being

Walter Benjamin’s philosophy of language offers a potential path beyond this antinomy between the form and content of language. According to him, “all communication of the contents of the mind is language, communication in words being only a particular case of human language and of the justice, poetry, or whatever underlying it or founded on it.”¹¹ All expressions of mental life are a kind of language, which for him means that language is not only coextensive with human expression, “but with absolutely everything.” In this light, language is neither a tool nor a vehicle through which we express thoughts, but the medium in which we communicate. This must be so because any and all criteria we could use to judge or measure language can itself only exist within language, making language itself something incommensurable. The mental content need not be entirely subsumed by language such that we simply identify all of mind with language; rather, it is simply to respond to the question “what can language communicate?”¹² with the answer “that which is communicable in that mental content,” or what Benjamin calls its “linguistic being.” It is this linguistic being and its possibilities and “not its verbal contents [that] defines [language’s] frontier.”¹³ When we conceive of language as a question of mediation and not as utilization or means, we have shifted our conception from a notion of language as a tool to an imminent one of language as a ground.

An imminent approach to language means there is nothing we can appeal to for judgment outside of the conditions of its existence and that which is found in our experience.¹⁴ Every human expression of an idea can only express a concrete relation to a thing in the world, for there is nothing else, no wellspring beyond that which exists to draw ideas from. That is not to say that every expression in language directly corresponds to tangible fact, but that every expression is in principle based on some encounter with them. Our finitude—that is, the fact that we can only approach things as embodied beings existing in limited passages of time—means that we can never conceive of ideas as if in a museum of inert objects on display. We are always affected in some way: my initial idea of a dog could not be a pure idea of “dog” in general, but is determined by my actual overly long, somewhat annoying walks with my dog and the way he’s comforted me on difficult nights. Recall that Benjamin said that what we express about things in language is that which is communicable about them. We must add to this and say that we can only express that communicable content insofar as we are or have been affected by it, for otherwise we would have no conception of it whatsoever.

In this sense, every human expression, no matter how strange or alien, shares in a common reality and is, simply by virtue of being expressed, in some amount of harmony with all the others. Those expressions that fail to find common ground in a common conception—by virtue of being highly subjective and personal, for instance—are called “inadequate.” In common language, we say these forms of communication “fall on deaf ears” or that they are “confused.” In an imminent conception of language, there is nothing “lacking” in the kinds of inadequate language one sees in psychosis. It expresses mental content and is limited by the finitude of thought and affection just as Arabic or English are, but it can be called “inadequate” insofar as it fails to translate that linguistic expression and is therefore excluded from a common linguistic community. 

If there is, as Benjamin suggests, a language of sculpture, of painting, and even of things in nature, then it stands to reason that all those who, in psychiatric terms, have been relegated to actual silence or the silence of reason have some manner of language. By bringing Benjamin’s argument into the sphere of psychiatry or to the question of psychosis, I am not at all implying that since all beings express something in language that therefore all communication is the same and should be treated the same. Even if all things are expressive and have some kind of language, humans speak languages that are characterized by names. We speak languages that communicate by means of words that are ultimately names for things, actions, ideas, etc. Anyone who has encountered someone in the state of psychosis has likely been met with mysterious formulations that seem to correspond to nothing, or is forced to respond to stated facts that cannot be proven or assertions that don’t follow the course of the conversation but appear seemingly out of nowhere. In a very simple sense, the names of things in psychosis are so different from the typical names or the combination of ideas is so unusual, they fail to produce any intended effects. 

Psychotic language is commonly the source of intense anxiety and fear, but there is no reason to fear a breakdown in effective communication in-itself. It is hardly an uncommon experience to encounter words or strings of words we do not recognize or that fail to affect us in the intended way. A speaker of German would never claim that a speaker of Italian does not have language simply because she doesn’t know any of the names for things in Italian. Even in our own languages, we regularly have the experience of hearing familiar words while misunderstanding what they refer to. I’m sure almost everyone reading this has had the experience of engaging in an argument only to be told “that’s not at all what I meant!”; or reading various intentions or ideas into letters or text messages that weren’t there at all like when someone says “I’m busy” and we assume they are furious with us about some mysterious thing; or attending a lecture (or viewing a documentary) about an unfamiliar topic and having the sensation that they’re speaking an alien language. The fear is based on the fact that, if someone can explain the meaning of a lecture or tell us what the French speaker is trying to say, the person in psychosis lacks such a mediator because the language is singular. Even so, subjectively, there is no immediate difference between failing to apprehend a foreign language and psychosis. In this sense, we can think of psychotic language as a foreign language proper to a single being. Usually, when we have an encounter between two or more distinct linguistic beings, understanding can only come to some manner of understanding through an act of translation. What can the theory of translation teach us about a language proper to a single being?

The Linguistic Encounter

Following Benjamin, the task of translator cannot be to replace the words of the original language with the most literal corresponding words in the second. Any speaker of two or more languages knows that this produces the ugliest monstrosities that bear very little resemblance to the original. The kinship between languages that allows them to be translated at all is not to be found purely in what is signified by each and every word, otherwise all translation would be a matter of replacing each and every word. This is so because, although “all individual elements of foreign languages—words, sentences, associations—are mutually exclusive, these languages supplement each other in their intentions.”¹⁵ In the first language, what is meant is not equivalent to single words or sentences, but emerges from the flux of language as it is lived in the encounter with concrete events in the world. In Benjamin’s example, even though Brot and pain both mean “bread” in German and French, respectively, the way they “come to meaning” is different. In both cases, the same thing is intended (das Gemeinte, what is meant) but the way they arrive at the intended meaning (Art des Meines, way of meaning) is exclusive to each. The words “Geisteskrankheit” and “mental illness” mean the same thing, but Geist can mean “spirit” in addition to “mind” and is recognized as part of a different tradition of thought (e.g. the tradition of German idealism and Hegel) than the English word “mental.”¹⁶ This would immediately come to mind for the German, but is unknown to the monolingual English speaker. This is to say nothing of the countless associations that different words bring to mind through rhyme or etymological roots. Every language attests to countless “ways of meaning” that make them incommensurable at the macro level, while every individual speaker has innumerable singular connections and associations. To think of language in this way requires one to shift their perspective of language from discrete units considered in the abstract to language as the medium in which subjects find expression as living beings. 

Though we have up to now discussed language primarily on a theoretical level, there are concrete ways in which these insights can inform the therapeutic encounter between patient and healer. What this theory of translation suggests is that a real linguistic encounter between a psychotic patient and a healer cannot occur when the physician’s “normal” mode of expression is prefigured as the correct form, but nor is it a matter of romanticizing and elevating ultra-subjective forms of expression proper to psychosis as if they held mysteries that were true in themselves. Instead, the encounter only takes place when each party risks their subjectivity in openness to the language of the other and allows a common mode of expression to unfold. Benjamin quotes Rudolf Pannwitz on what makes for a bad translation: “They want to turn Hindi, Greek, English, English into German instead of turning German into Hindi, Greek English… The basic error of the translator is that he preserves the state in which his own language happens to be instead of allowing his language to be powerfully affected by the foreign tongue… He must expand and deepen his language by means of the foreign language. It is not generally realized to what extent this is possible, to what extent any language can be transformed.”¹⁷ It stands to reason that translation, as Benjamin sees it, is equivalent to neither the production in the first language nor the new work in the second, but is something that could only exist by virtue of the encounter between the two. Translation is a third space of communication built between two incommensurable, mutating mediums through difficult, slow work. It might be going too far to say that we need to “translate” psychotic language, for this implies too much (that it’s not English or Spanish because it’s psychotic, that “sanity” itself has a language), but the requirements for good translations are in essence the same as those for a productive linguistic encounter for someone in psychosis. This approach has been attested to on numerous occasions in history, but let’s consider the particularly clear example of Nise da Silveira’s art practice in Brazil.

Born in 1905, Silveira was the only woman to graduate from her medical school in Bahia. In 1936, during the Vargas regime (right before and through the Estado Novo), she was arrested and spent 17 months in prison plus 8 years in forced exile for having Marx books in her locker. When she returned to practice at the Pedro II psychiatric hospital (Brazil’s first) in Rio de Janeiro in 1946, she was horrified at the complacency of care and the impulsive recourse to aggressive treatments like electroshock or induced comas being administered as managerial shortcuts.

Nise da Silveira in 1970 (wikipedia)

That same year, she introduced a new art therapy practice that operated under the assumption that the final product itself was not of primary importance. Two principles regulated her art practice. First, verbal language, or specifically words, are only one among many means of expressing one’s mental life and the prejudice for verbality has led psychiatry to vastly underestimate the expressive capacity of its patients. “There are schools that study the images,” she wrote “but understand that the painted images serve only as means to develop verbal expression, that is considered to be by them the only valid language. [...] For us, the image is valid in its own value, it speaks by itself, and eloquently.”¹⁸ Here she is responding above all to Freud, who wrote that “the interpretations made by psycho-analysis are first and foremost translations from an alien method of expression into the one which is familiar to us.”¹⁹ For Silveira, the image is in itself communicative, and not necessary linguistically. This is true for anything with the capacity to affect another. Expression and perception through artistic practice in a space occupied in common constitutes a sufficient and complete social world. It is not “lacking language.”

Second, the act of production in a group—producing art in this case, but the same principle applies for other practices—is a necessary condition for cultivating a linguistic community. Like Spinoza, she denied that true and false ideas arise from different sources, and insisted that no matter how foreign a language may seem, it draws from the same worldly material as any other. She said: “It is said that there is a source of wisdom and a source of madness, but they are one. There are no separate sources, they are interrelated.”²⁰ In the act of production, those who apparently lack affect, sociality, or coherent intellect can become part of a common process and therefore a common language. The practice of making art is not about producing a work that will perfectly express one’s mental content, but ought to “[coordinate] intimately hand and eye, sentiment and thinking, body and psyche,”²¹ that is, it ought to prepare, increase, and refine the powers of expression through richer contact with a social world. Silveira persisted through innumerable challenges and threats, later introducing animal companions and ceramics into the studio. The hospital administration was so hostile to her alternative means of cultivating relationships and saw her as such a threat that they once killed the dogs she introduced as companions and left them in the courtyard for her to find. Unsurprisingly, she eventually went on to found an outpatient clinic/short term respite called Casa das Palmeiras where she could pursue her practice more thoroughly. 

A true linguistic encounter, that is, one that succeeds in creating a bridge from one speaker to another or results in the formation of a linguistic community or network, requires patience and openness. As Silveira reminds us “It will take perseverance, patience, and an environment free of any coercion so that relationships of friendship and understanding can be created. Without the bridge formed by that relationship, healing will be almost impossible.”²² The first condition is everyday trampled on by the necessities of institutional management and insurance that prioritize speed and technical intervention above the slow work of building a common language. The second condition requires to some extent a subjective reform on the part of the healer, who must relinquish the presumption of linguistic and rational superiority. However, such a reform is unlikely to take place in institutional spaces that daily remind patients and physicians of who observes and dominates and who is merely acted upon as an object of inquiry. To conclude then, we can say that the effective linguistic encounter, the mutual production of and in language, would require a fundamental change in the institutional conditions governing psychiatric care.

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A brief Q&A with Sasha Warren

Vocabularies of Silence: Follow-Up

See also:

Whereof One Cannot Speak: Richard Gipps on Madness and Rational Understanding

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1. Blaise Pascal. Pensées (London: Penguin Books, 1995), 29.

2. John Haslam. Illustrations of Madness (London: Routledge, 1988), 15.

3. Quoted in: Andrew Scull. “The Domestication of Madness,” Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective (Berkeley: University of California Press, 1989), 75

4. Sigmund Freud. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIII (1913–1914) (London: The Hogarth Press, 1958), 176.

5. Hans Prinzhorn. Artistry of the Mentally Ill (New York Springer-Verlag, 1972), 13.

6. Karl Jaspers. General Psychopathology (Chicago: University of Chicago Press, 1968), 185.

7. Karl Jaspers, General Psychopathology, 307.

8. Ibid, 305.

9. Ibid, 307.

10. “The term delusion is vaguely applied to all false judgments that share the following external characteristics to a marked, though undefined, degree, (i) they are held with an extraordinary conviction, with an incomparable, subjective certainty, (2) there is an imperviousness to other experiences and to compelling counter-argument; (3) their content is impossible.” Ibid, 96. By this standard, it should be said that I am focused on the formal elements of language and how we understand or interpret meaning through them, rather than the question of whether something is delusional or not.

11. Walter Benjamin. “On Language as Such and on the Language of Man,” Selected Writings Volume 1, 1913–1926 (Cambridge: Harvard University Press, 1996), 62.

12. Ibid, 63.

13. Ibid, 64.

14. For Spinoza, the preeminent philosopher of imminence, God is the only substance, which is everything conceivable. As humans, we exist as finite modes of that infinite substance with but a few limited means of expressing God’s infinite nature. There may be infinite attributes through which to know or experience things, but he only discusses two: thought and extension in space. For Spinoza, these are two different ways of knowing and experiencing the same things. Therefore, “the order and connection of ideas is the same as the order and connection of things.” Benedict de Spinoza. The Ethics and Other Works (Princeton: Princeton University Press, 1994), 119.

15. Walter Benjamin. “The Task of the Translator,” Selected Writings Volume 1, 1913–1926 (Cambridge: Harvard University Press, 1996), 257.

16. Geisteskrankheit is accepted, but no longer the standard term for “mental illness.” The more limited psychische Krankheit is more likely now.

17. Ibid, 262

18. Vitor Pordeus, “Nise da Silveira: Brazilian Pioneer in Art and Transcultural Psychiatry,” 5–6, draft paper, https://www.academia.edu/34364588/Nise_da_Silveira_Brazilian_Pioneer_in_Art_and_Transcultural_Psychiatry.

19. Sigmund Freud. The Standard Edition of the Complete Psychological Works, 176.

20. Nise da Silveira, Nise da Silveira—A Revolução Pelo Afeto [The Revolution by Affection] (Rio de Janeiro: Studio M’Baraká, 2021), 190.

21. Eliane Dias de Castro and Elizabeth Maria Freire de Araújo Lima, “Resistance, Innovation and Clinical Practice in Nise da Silveira’s Thoughts and Actions,” Interface [Botucatu], Selected Edition (2007): 10.

22. Nise da Silveira, Nise da Silveira—A Revolução Pelo Afeto, 194.