The Other Self: Psychopathology and Literature

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inspired and were even embodied in some literary protagonists. ... The first is the psychological double who steals the identity of the protagonist and pursues.
J Med Humanit DOI 10.1007/s10912-011-9148-2

The Other Self: Psychopathology and Literature Javier Saavedra Macías & Rafael Velez Núñez

# Springer Science+Business Media, LLC 2011

Abstract The figure of the “double” or the other self is an important topic in the history of literature. Many centuries before Jean Paul Richter coined the term, “doppelgänger,” at the beginning of the Romantic Movement in the year 1796, it is possible to find the figure of the double in myths and legends. The issue of the double emphaszses the contradictory character of the human being and invokes a sinister dimension of the psychological world, what has been called in German as “umheimlich.” However, does multiciplicity always involve pathology? Related to this figure in literary history, a new perspective from clinical psychology called “dialogical self” defines the self as a multi-voice reality. Along the same line, postmodernist psychology considers the self a discursive construction. From these perspectives, the “self” is situated a long way away from the classical essential conception of the self. In this paper, we review briefly some important landmarks of the figure of the double in the literature, and we compare the coincidences of the “double” experiencies described in literature with the experiences of our patients. Finally, we discuss how this literary tradition can help us to understand new psychological perspectives. Keywords Psychopathology . Literature . Double . Self . Identity

Der Mensch ist nie allein: das Selbstbewußtsein macht, daß immer zwei Ich in der Stube sind. Man is never alone: self- consciousness means that there are always two of you in the room. Jean Paul What view of identity has been privileged in western culture and academic psychology? According to Bruner (1990), the “self” has traditionally been viewed as a substance or essence whose existence was prior to or independent of our social practices and the way in J. S. Macías (*) Department of Experimental Psychology, University of Seville, Seville, Spain e-mail: [email protected] R. V. Núñez Department English Studies, University of Cádiz, Cádiz, Spain

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which we describe ourselves. Thus, identity has been understood as an internal dimension that belongs to subjects and to individuals rather than an interactive feature. Identity has also been described as a stable and reliable trait through which we can recognise people. It can be depicted as what is similar and what remains stable in the long run: that is, the essence of a person. In psychology we can measure these traits using standardised instruments. Identity makes us recognisable and predictable in society, and we are allowed to participate in society. From a sociological perspective, Bauman (1998) argues that to achieve its project, based on the enlightenment ideal of progress, industrial society needed human beings with a coherent identity, one that was unitary, stable over time and able to suppress desire. The literary genre that best reflects this essential identity is the “bildungsroman” in which the hero develops his identity from childhood or adolescence into adulthood, the typical progressive story of the self-made man. However, if we explore mythological literature and ancient art, we see that for thousands of years the nature of human beings has been considered, at least, as dual. For example, in the epic of Gilgamesh, probably the first mythological story, the semi-god king of Uruk, Gilgamesh, faces his double, Enkidu, who is sent to him by the goddess Aruru. Enkidu is half-man, half-wild animal. At the end, Gilgamesh discovers the mortal dimension of Enkidu and must cope with his death. Many systems of age-old beliefs are based on a dualist conception of nature. For the Taoist tradition, based on the philosophy of Lao Tse, the Chinese philosopher from the 4th century B.C, all human beings are born with the opposing principles of the “yin” and “yang.” In Mesoamerica, we find a dualist view of the world in many pre-Columbian cultures. Some primitive beliefs about the soul may also be classified as dualist. For example, the Egyptian “ka” is a vital principle that could live outside the body–a synonym of the soul, represented by the Egyptians as a shadow. This motif, the shadow, holds a privileged place in double literature. Moreover, the importance of the dual or multiple nature of the human being is demonstrated by the large number of names or terms for referring to it in different cultures: for instance, sosia in Greece and Spain, alter ego in Rome, coimimeadh in Scotland and fetch or wraith in England. The motif of the double has been and still is highly important in the history of literature. Different forms of experimenting with duality or multiplicity have played central roles in essential works from Plutarch through Shakespeare to the romantic and gothic literature with which we shall deal. But what makes the experience of duality or multiplicity in the history of literature and its presence in innumerable religious or mythological traditions so important? The reason for this extraordinary presence is rooted in two dimensions of the human condition, which appear as central axes in double literature. The first dimension is psychological. An essential form of duality in all human beings is tied to the acquisition of consciousness. Looking at oneself, thinking about oneself implies becoming objective, seeing oneself as different. The discovery of a not–I either internal or external–in other words, social–is vital for the birth of the experience of identity. Together with consciousness is born language, the ability to talk to oneself. Language is the most effective instrument for becoming objective. It is no surprise that the process of individualization and the appearance of language in human evolutionary development come together. For this reason, some philosophers have defined the “self” as a split and, at the same time, a synthesis of opposites in whose dialectics “one of the terms remains its opposite” (Kierkegaard 1983). The second dimension is moral. This source of duality is directly related to the motives and drives that push us in different, sometimes opposing, directions. The human being is continuously compelled to choose between different actions and their consequences. These actions may respond to different motives and objectives in the same person and at the same

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time. This human experience is directly related to the question of the origin of evil and the freedom of the human being to avoid it. In line with Herdman (1990), this dimension of the human condition is the one that provides the most richness and authenticity to the double in the history of literature. For this author, the paradigmatical model of this conflict in western culture is reflected in the oration of Jesus Christ in the garden of Gethsemane: “Father, if thou art willing, remove this cup from me; nevertheless not my will, but thine, be done.” Apart from these two basic experiences of duality, we analyze the reason for the double from two perspectives. First, we reflect on the similarities between the experiences of the characters in books covering the subject “of the double” with the experiences of people suffering from severe mental disorders. This is not to pathologize the experience of the characters in literary works but to comprehend the experience of people with severe mental disorders within the two universal dimensions of duality described above. This latter idea is a very important one, the reason why the study of literature may be very useful for all those who work in the area of mental health. Second, we explore the historical and cultural factors that influence how we understand the identity and the moral conflicts reflected in these works. For example, how scientific or pseudoscientific theories, such as mesmerism, inspired and were even embodied in some literary protagonists. In the following section, we explore different ways of representing otherness or multiplicity in literature, in particular romantic and gothic literature through the experiences of several major characters. In the third section, we look at the experiences of duality or multiplicity of people with severe mental disorders–particularly schizophrenia–and compare them with the literary tradition. Finally, in the discussion we emphasize the existential value of experiences which, from a clinical perspective, we call “psychotic symptoms” and reflect briefly on the latest conceptions of identity in psychology1.

The figure of the double in literature It is not our intention in this section to perform an exhaustive exploration of the figure of the double in literature. We are concerned solely with describing certain features of characters’ experiences in this type of literature that may help us approach psychopathological symptoms from a different perspective. We first explore representations of alterity in literature up until the romantic double as the extreme experience of otherness. Independent characters who work as alter-egos are found in literary stories such as Sancho Panza and Don Quixote in the novel by Miguel de Cervantes Saavedra in which different archetypal perspectives of the world are represented. Some authors have used the term “quasi-doubles” for extreme forms of this type of representation (Frank 1976). The quasidoubles are always completely independent; in other words, they have a separate reality in the plot, but they reflect inner images, mirroring each other, laying bare a profound conflict 1

The authors declare that the extracts from interviews with people with severe mental disorders that are discussed in this article were obtained after reporting on the method and objectives of the research to the institution where patients live and obtaining their consent (FAISEM. Andalusian Public Foundation for the Social Integration of Persons with Severe Mental Disorder). The institution was continuously informed about the development of the ongoing investigation. The interviewees agreed to participate freely. None of the patients who showed doubts about their participation was interviewed. Those who agreed to participate were given a document signed by the main researcher to ensure that data could only be used for scientific reasons and that the identity of interviewees would be confidential. To avoid any possibility of recognition, all personal information—age, sex, diagnosis or date of the interview—has been removed. Similarly, any information within the extracts that could identify patients, such as proper names, has been deleted or modified.

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at the same time as mutual dependence. Dostoyevsky’s The Brothers Karamazov and The Idiot also contain some examples of these doubles. In recent years, we have discovered very similar examples of this type of doubling in two contemporary works: Life and Fate by Vasily Grossman and The Kindly Ones by Jonathan Little in which a meeting between a Nazi officer and a communist official during World War II work as archetypal mirrors of one another. A second way in which we find some kind of alterity in literature is the use of secret twins to create dramatic or comic situations. This type of intrigue is almost a literary subgenre because of the large number of works. There are many examples from the plays of Plutarch to the optimistic novel of Antony Hope, The Prisoner of Zenda. One of the most famous is William Shakespeare’s Comedy of Errors. We also find circumstantial doubles who appear for no apparent reason or because of supernatural causes. Plutarch’s play, Amphitryon, is the best example. In this play, the god Zeus takes the form of Amphitryon, a Theban general, to have sex with his wife, Alcmene, while he is fighting in a battle. This play has been reinterpreted by many writers including Moliere and Kleist. The type of double on which we focus is the Romantic double, which involves an internalization of the double. Romanticism transformed the double into a sinister, psychological and moral issue–umheimlech in German. The German term that describes this type of double is doppelgänger, coined by Jean Paul in a novel called Siebenkäs in 1796, as the concept of people who see themselves (Paul 1960). The cornerstone of the doppelgänger motif is the paradox of encountering oneself like another. Put another way, it is the most radical expression of otherness: ‘I’ as ‘other.’ While the representation of the double in literature is both diverse and complex, making it nearly impossible to classify in a systematic way, there are two expressions, two ways of experiencing the double in romantic and gothic literature which we will dsecribe. The first is the psychological double who steals the identity of the protagonist and pursues him. The double continuously threatens the social position of the protagonist, making life impossible. Romantic literature transforms the external double into an inner double, an independent consciousness that torments the victim. This inner double may appear in many different ways and may be experienced as an outer being who threatens to invade the protagonist’s identity. In fact, the external materialization of the double as another character in the plot, together with the moral conflict and the theological reflection of evil, have been considered the cornerstone of the romantic double. These characteristics faded with the growth of the influence of positivist psychological science during the 19th century where the experience of the double was described, from a clinical perspective, as a psychopathology (Herdman 1990; Miller 1985). We find the best illustrations of this kind of double in the novel, The Devil’s Elixir, first published in 1815, which deals with the adventures of Brother Medardus, an 18th-century Capuchin monk. Brother Medardus is chosen to take a message to Rome. On his journey, he is involved in a game of double impersonation. Complex and rich, Hoffman’s novel contributed greatly to the development of the double, exemplified by the following passage: I no longer walked alone! On the contrary, it seemed to me as if some person ran all the way very near me, keeping time with my steps, and I heard a stammering voice, which pronounced the words—Ever, ever am I with thee! Brother, brother Medardus! Go whither thou wilt, east, north or south, I am ever with thee! […] I became convinced that this horrible double, by whom I was haunted, had his existence only in my own disturbed imagination. However, I could by no means get rid of the frightful images. ((Hoffman 1824), 96)

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The passage illustrates the process of internalization of the double in which the protagonist recognizes that the double is a product of his imagination. The horror transmitted by the character comes from his experience of the loss of identity, from an alien influx that reflects hidden aspects of his own self. This process makes one a stranger to oneself, an object, a thing possessed by an unknown self. One of the best stories for observing the connection between the figure of the double and the consciousness that we describe above is Poe’s “William Wilson,” a short story with Gothic overtones written in the first person in which the protagonist is pursued and tormented by a double from his childhood until his death. The double, exactly like the protagonist, even has the same name, obstructing and preventing all of the bad actions of the protagonist. At the end of the story, the protagonist kills his double, discovering that he has killed his conscience and, in so doing, has killed himself. In this extract, after stabbing his double, the protagonist discovers that the double’s voice is his own: […] It was my antagonist—it was Wilson, who then stood before me in the agonies of his dissolution […] It was Wilson; but he spoke no longer in a whisper; and I could have fancied that I myself was speaking while he said –“You have conquered, and I yield. Yet henceforward art thou also dead—dead to the world and its hopes. In me didst thou exist—and, in my death, see by this image, which is thine own, how utterly thou hast murdered thyself. ((Poe 1988), 178) As Miller (1985) writes, the originality of the double in “William Wilson” lies in its role as the “admonitory conscience.” In other words, the double is freed from bearing the protagonist’s evil not only because it is conscious of his evil acts but also because it assumes the moral essence still remaining in the protagonist. This story highlights the relation of the double with the existence of the conscience, of the reflexivity that characterizes the human being. Once the double dies, once the conscience has been eliminated, the human being is no longer a human being and dies. Thus, the experience of duality is seen as inseparable from the human condition. This episode, in which the protagonist kills his double to discover that he no longer exists, is characteristic of the literature of doubles. Another example is the short story, “The Horla,” published in 1887 by Maupassant. For some critics such as Herdman (1990), Maupassant’s story represents a decline in the figure of the romantic double as it reduced its sinister ambiguity, reflecting the influence of positivist psychological scientific thinking and the disappearance of moral conflict from the plot. “The Horla” is written in the form of a journal: the narrator, an upper-class, unmarried, bourgeois man expresses his painful thoughts and feelings of anguish because he is being possessed by a powerful and invisible extraneous presence: August 14. I am lost! Someone is in possession of my mind and controlling it! Someone orders all my acts, all my movements, all my thoughts. I am no longer master of myself, nothing except an enslaved and terrified spectator of the things which I do. (Maupassant et al. (1986), 333) In this passage is an example of the ultimate extreme of the loss of liberty, the end product of the pursuit of the double: total possession. The hero, pursued by his double, runs the risk of ending up as a robot, becoming an automaton of himself. The figure of the automaton and the experience of possession are very frequent themes in literature and in the experiences of people who suffer from severe mental disorders. The double is also found in literature as a split personality or dark half of a protagonist acting as a physical manifestation of a dissociated part of the self. This type of double

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breaks away from the protagonist’s self, possibly satisfying the latter’s desires initially, but then becoming uncontrollable and eventually destroying the hero’s life. A good illustration of this type of double is Stevenson’s Dr. Jekyll and Mr. Hyde (1886). Another version of this kind of double is Wilde’s The Picture of Dorian Grey in which the picture becomes a progressive representation of the dark and evil soul of Dorian Grey (1891). In this work, the protagonist dies after destroying the portrait much as the protagonist dies on killing his double in “William Wilson.” The following passage from Dr. Jekyll and Mr. Hyde illustrates how Dr. Jekyll wants to free the good part of his consciousness, or put another way, resolve the problem of the duality. This way, each part of the self would be housed in separate identities. His attempt to overcome the human condition has terrible consequences: […] I saw that, of the two natures that contended in the field of my consciousness, even if I could rightly be said to be either, it was only because I was radically both […] If each, I told myself, could be housed in separate identities, life would be relieved of all that was unbearable […] no longer exposed to disgrace and penitence by the hands of this extraneous evil. ((Stevenson 1886), 109) Whatever the appearance of the double in literature—robbed reflection, shadow, spectral brother, imaginary replica terrorizing a protagonist–the figure gains meaning when it is contextualized in the dimensions of the human condition. The figure of the double places the human being in front of the mirror, is a metaphor of the reflective nature of human existence. The literature of the double self, particularly in the romantic tradition, emphasizes the close relationship between the figure of the double, consciousness and death. Put another way, the moment that we acquire consciousness, the capacity to observe ourselves, the experience of alterity, the double, appears. The experience of the double, therefore like consciousness itself, is part of the human condition. In fact, the price that we have to pay for having consciousness is seeing oneselves “dead”: being conscious of our own mortality. Thus, the figure of the double anticipates, announces or brings with it death. The double in literature reflects the manifestation of evil, as in “The Devil’s Elixir” by Hoffman or in the classic Scottish gothic novel, Private Memoirs and Confessions of a Justified Sinner by James Hogg, or it is the hand accusing the protagonist of depravity in Poe’s “William Wilson.” The appearance of other doubles is due to the intervention of characters. In line with Herdman (1990), concern over the existence of free will is the central axis of the romantic double. The figure of the double shows how impossible it is for the protagonists to escape from their destiny, from the inheritance of family evil as in “The Devil’s Elixir.” Or the inability to resist the power of evil that takes over the identity of protagonists until it creates automatons, as happens in “The Sandman” also by Hoffman (1982). It is no surprise then that Hoffman and other German writers were influenced by the pseudoscientific doctrines of “animal magnetism” of G.H Schubert and Mesmer’s “magnetic union of souls.” If we are inhabited by different pulsions, if we cannot escape from our own selves, how can we act and live in a society with a split identity in accordance with the regulations? The main characters in the works mentioned above struggle towards integration in society by repressing or trying to control their other selves. The social norms described by romantic authors as frivolous, bourgeois and tedious are the ones from which both characters and authors are trying to escape. In the following section, we describe the experiences of people with psychosis from a phenomenological perspective to see if they bear many commonalities of double characters.

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Psychopathology and literature: People with severe mental disorders as romantic heroes When we live or work with a person diagnosed with a severe mental disorder, such as schizophrenia, we observe how they fight to present a coherent image of themselves. They have difficulty achieving a recognisable and reliable self that allows them to participate in society, and the basic categories of human existence have broken down. According to Laing (1960), from an existential perspective, such people are afraid of being swallowed up by the external world and may think that others can penetrate their minds or read their thoughts. They also feel a void and wish to make contact with the world, but at the same time they are afraid of being fragmented by strong feelings. Finally, they fear being turned into automatons, feeling petrified, or having the power to transform other people into automatons. The “self” of these people is constantly under threat. These selves have been described as cacophonous, empty or monological (Lysaker and Lysaker 2002). In any case, some patients are virtually incapable of integrating different social positions into their identity, and their discourse is completely incoherent (Saavedra et al. (2009). From a biomedical and psychobiological perspective, the morphology and content of these experiences can be understood as epiphenomena of neurobiological maladjustment or cognitive deficits. However, if we delve further into the lives of such people we become aware of the same existential value as in the experiences of the literary heroes. The following are examples from narrative interviews with people diagnosed with severe mental disorders. To avoid any possibility of recognition, all personal information such as age, sex, diagnosis or date of the interview has been removed. Interview 1 Interviewer: Did you live there with your mother? How many brothers do you have? User: I have four, thanks to god. But my mother had more and because of the posh man I do not have any more brothers. The posh man is revolting! U: And is the posh man a person? I: He is a person. The day he dies, I’ll be cured. U: And where is he? Can you see him? I: Yes, I see him in my imagination. Do you know what an unreal number is? An unreal number is fractioned, a fraction of the reality, the unreality is a fraction of the reality, it is to think that… do you know? I: So, the posh man is in your head? U: Absolutely, he threatens and coerces me! The posh man killed my mother, he has taken my life, he threatens and coerces me, he has made me a schizophrenic, he has destroyed my family, and the posh man is an illness. In this excerpt, there are several similarities with the last two literary texts. First, the patient tells us about a presence that has tormented him throughout his life. This character, the posh man, has even killed the patient’s mother and is described as an illness. The patient is completely dominated by this character and recognises that this character is a product of his imagination although he talks about him like an external person during the interview. Many delusional complexes try to explain the existence of the evil, sometimes it consists of the patient’s real or imagined bad actions as in the following extract. Interview 2 User: From the age of 16 to the age of 18. Two things happened to me, the two things which happened to me, were both bad things. Once a kind of black spirit came in

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through my mouth. Interviewer: A kind of what? U: Black spirit! A kind of black spirit! I: Ah! A black spirit. U: A black spirit came into me and I committed an offence of indecent exposure. I was caught by the Civil Guard Police because I did not want to do anything.… I did not want to do anything…. This case of indecent exposure happened because I was possessed. Afterwards I went to sleep in.… And both cases were similar… as if I were possessed. In this interview, the patient makes a black spirit responsible for his offences of indecent exposure. Here the black spirit works like a double and the patient exonerates himself from blame for the crime. However, he has paid a high price. Finally, this patient was immersed in a really complex delusion in order to explain all the evil in the world; he even identified himself as Satan. As in the literature, doubles provide a medium for explaining the evil that cannot be accepted morally by the protagonist. An evident issue in common between double motifs in literature and the experience of madness, including hallucinations and delusions, is how to achieve a stable and socially recognisable identity based on fragmented events and chaotic relationships and perceptions. Like protagonists of doubles in literature, people with severe mental disorders can find it hard to recognise themselves as social agents; they may discover new disrupting and threatening identities or have problems recognising significant people in their lives. In this second excerpt, the same patient is very worried because people call him “Satan”; in other words, they confuse his identity. Interview 2, continued: U: Even children called me Satan. I said, call me George! My name is George! They wanted to put Satan in hell; they wanted to put me together with Satan because I was looking for him to warn him what was going to happen in Seville. I wanted to warn him to avoid the war. As illustrated in this extract with a patient who has undergone a divorce 2 years earlier and is now living in a care home, he expresses doubts about whether he actually is a father. While he says he knows that his wife has some children, he neither knows them nor is he sure of his paternity. Interview 3 U: I don’t know who my sons are. A boy who is in the world and I don’t know him. I’ve been looking for them for a long time. I: Do you want to see them? U: Of course, two children who said that they are my children visited me last night. They pounded my head all night I: And did they pound…? U: Yes pounding my head, the voices, they did it. They will make me kill myself. I: And do you hear them? U: I hear them as if they were angels and they were stamping on the head of their father. The ambiguous social position of the patient as father and husband and the inability to elaborate a coherent story is reflected in the voices of his children’s doubles: “two children who said that they are my children.” The voices torment him and even incite him towards

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suicide. Amongst people with severe mental disorder that we have interviewed, consciousness of death is a central topic. For example, some patients believe that the world is about to be destroyed. One of us (JS) knew a patient who believed that he was dead, he saw himself as a dead man. The position in the world of the literary protagonists is very similar to those of the patients in these extracts. So much so that in some cases, it would be difficult to differentiate between extracts from patients’ experiences and the literary characterizations of doubles. Moreover, the above referenced patients do not identify the protagonists of their delusions as doubles, much like the literary heroes do at the end of their stories when they recognize them as such, as in Maupassant’s short tale “Le Horla.” However, from a discursive perspective not only the protagonists of some delusions but also the doubles in literature can be interpreted as fragments of the patients’ or literary heroes’ identity that cannot be integrated in a coherent narration of themselves. Thus, the figure of the double in literature can help interpret some experiences related to madness from a new and productive point of view. Both the literary characters and the patients are pursued by beings, and while they are neither recognized nor accepted, at a discursive level they may be identified as particularly conflictive positionings of the self, especially illustrated in interviews two and the second part of 3. These positionings of the self that are nearly always related to actions considered evil or with ambiguous emotions may be externalized in the form of auditory hallucinations or form part of a persecutory delusive complex (Saavedra et al. in press). Both patients and literary heroes are concerned about their social integration. Patients and literary heroes anxiously fear an imminent dissolution of their self or predict their own deaths. Finally, both patients and literary heroes are anxiously aware of the multiplicity of their self, of the multiple dimensions of their identity which they are unable to integrate.

Discussion Romantic and gothic literature relate the experience of duality or multiplicity mainly as a sinister event that foreshadowing death or the dissolution of the self. Later, with the influence of scientific psychology at the end of the 19th and beginning of the 20th centuries, it became identified with pathology and by the second half of the 20th century, social sciences and psychology began to understand identity as multiple. Undoubtedly, mid-century postmodern philosophers such as Foucault, Baudrillard, Lyotard and Deleuze have severely criticized the modern concept of “identity,” initiating the decline of the essential self (Lyotard 1984) and the concept of the essential self has gradually eroded. In the wake of this decline, the social sciences have come to consider the experience of multiplicity as universal. In other words, all human beings construct their identity, their own self, with traces of experiences, meanings, desires and activities, often in conflict and dependent on the socio-cultural contexts in which they develop. This way, the negative nature of multiplicity has steadily lost intensity and has even acquired positive values, particularly in a world where flexibility and complexity of social networks are the rule (Gergen 2001, 2009). The eruption of the metaphor of the narrator, understanding the human being as a narrator, or as a living being who is continuously telling and being told stories to make sense of his or her life experiences within a specific community, means questioning two of the mainstays of the psychological tradition: the existence of elements of an essential internal reality and the existence of a completely individualized and autonomous human

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being. Bruner (1990) coined the term of “distributed self,” a self distributed among different sociocultural scenarios in which it acts. Memory or intelligence from a cultural perspective has also been considered distributed or interpersonal. In an even more radical manner, Gergen (1985) moved away from the first formulations of psychology which saw the self as a stable structure. He conceives the narrative self imbued with the social properties of discourse and emphasizes the sociocultural nature of identity. Identity becomes a specific discourse which is the product of social exchange. Identity is a social construction. From what has been called the “Dialogical Self Theory,” Hermans (2001) conceives the “self” as a set of multiple, dynamic and relatively autonomous positionings in the landscape of the mind. From this point of view, the self can be transferred to different positions, even if they are opposing. When characters get underway in a story, they acquire their own lives with their own narrative requirements. Other authors have also reached conclusions that complement the above-mentioned. In two classic works, Watkins (1986) from psychology and Caughey (1984) from anthropology focused on this question. Watkins shows that the practical repercussions of the mental processes in which interiorized imaginary characters participate are exactly the same as in those in which real characters participate. In the same vein, Caughey found in his ethnographic research, Imaginary Social World, that imaginary relationships are very usual in the western world. Some of these approaches to identity are inspired by the contributions of the Russian literary critic Bakhtín (1987). According to Bakhtín, thoughts, ideas and memory–the inner world–embody multiple voices in dialog, be they real or imagined. Each person lives in a wide range of scenarios (worlds); in each scenario he or she builds a character who becomes an independent author telling his or her own narrative. This way, it is assumed that each self is made up of a great multiplicity of authors in continuous dialog, constructing a highly complex self. In summary, according to this perspective, self-construction is a sociogenetic process involving voices imbued with past meanings and intentions from the social contexts in which we live. In fact, the self of some schizophrenic patients and literary heroes can be defined as an amalgam of disconnected voices that prevent the patient from having a coherent and integrated identity. The powerlessness of people with schizophrenia and protagonists of doubles in literature to integrate these voices discloses the social and multiple nature of self. Literature should become a resource for learning and reflection for all mental health professionals as it brings us all closer to the subjective experience of “madness,” beyond diagnostic categories, emphasizing the struggle of protagonists to construct a communicable self on the fringe of the human condition. The experiences of the literary heroes we have reviewed, like those of people with severe mental disorders, gain meaning and existential value when they are conceived as an extreme case of the struggle of human beings to achieve a balance between their selves in conflict and build a coherent and shareable identity with the sociocultural values of the community in which they live. References Bakhtín, M. Speech genres and other late essays. Austin: University of Texas Press, 1987. Bauman, Z. Work, Consumerism and the New Poor. Philadelphia: Open University Press, 1998. Bruner, J. Acts of Meaning. Cambridge, MA : Harvard University Press, 1990. Caughey, J.L. Imaginary Social Worlds: A Cultural Approach. Lincoln: University of Nebraska. ChristianSmith, LK, 1984.

J Med Humanit Frank, J. Dostoevsky: The Seeds of Revolt, 1821–1849. Princeton, N.J: Princeton University Press, 1976. Gergen K.J. The Social Construction of the Person. New York: Springer-Verlag, 1985. Gergen K.J. The Saturated Self, Dilemmas of Identity in Contemporary Llife. New York: Basic Books, 2001. Gergen K.J. J. Relational being. Beyond self and community. New York: Oxford University Press, 2009. Herdman, J. The Double in nineteenth century fiction. London: The Macmilliam Press, 1990. Hermans, H.J.M. “The dialogical self. Toward theory of personal and cultural positioning.” Culture and Psychology 7 (2001): 243–281. Hoffman, E.T.A. The Devil’s Elixir. London: Blackwood & Cadell, 1824. Hoffman, E.T.A. Tales of Hoffmann. Harmondsworth, Middlessex: Penguin, 1982. Kierkegaard, S. The Sickness unto Death. Princeton: University Express, 1983. Laing, R.D. The divided self: An existential study in sanity and madness. Harmondsworth: Penguin, 1960. Lyotard, J-F. The postmodern condition: A report on knowledge. Minneapolis: University of Minnesota Press, 1984. Lysaker, P. and J. Lysaker. “Narrative Structure in Psychosis: Schizophrenia and Disruptions in the Dialogical Self.” Theory & Psychology 12 (2002): 207–220. Maupassant, G. “The Horla.” In Selected Short Stories, ed. by R. Colet. Harmondsworth, Middlesex: Penguin, 1986. Miller, K. Doubles: Studies in literary history. Oxford: Oxford University Press, 1985. Paul, J. Sämtliche werke. Munich: Hanser Verlag, 1960. Poe, E.A. The fall of the house of Usher and other writings. Harmondsworth, Middlesex: Penguin, 1988. Saavedra, J., M. Cubero, and P. Crawford. “Incomprehensibility in the Narratives of Individuals with a Diagnosis of Schizophrenia.” Qualitative Health Research 19 (2009): 1548–1558 Saavedra, J., A. Santamaría, P. Crawford, and G. Lucius-Hoene. “Auditory Hallucinations as Social SelfPositions: A Theoretical Discussion from a Single-Case Study.” Journal of Constructivist Psychology (in press). Stevenson, R.L. Strange Case of Dr Jekyll and Mr Hyde. London: Longmans, Green & Co., (1886). Watkins, M. Invisible guests: The development of imaginal dialogues. Hillsdale, NJ: Erlbaum, 1986.