HISTORY OF PSYCHIATRY

Dance, communication andschizophreniaJosephine Loftus

"Dancing possesses all the features of a beautifullanguage, yet it is not sufficient to know the alphabetalone. But when a man of genius arranges the lettersto form words and connects the words to formsentences, it will cease to be dumb, it will speak withboth strength and energy; and the ballets will sharewith the best plays the merits of affecting andmoving"

(Noverre. 1760;cited in Copeland & Cohen, 1983. p. 290)

"I should like to emphasise that some of the clinicalpictures outlined are no more than attempts topresent part of the material observed in a communicable form"

(Kraepelin. 1920:cited in Hafner et al, 1987, pp. 29-38)

At the time of Nijinsky's birth in 1889, ballet wasstill awaiting the 'man of genius' who wouldrealise its full potential as a self-sufficient form ofexpression. Psychiatry was still grappling withthe various faces of madness in an attempt toestablish a universally comprehensible language. By 1889 the term psychosis (originallymeaning animation of the soul), coined 40 yearsearlier (Beers, 1995b), was beginning to assumethe meaning which psychiatry attributes to ittoday. Kraepelin was about to formulate hisconcept of the psychoses which were so tragicallyto cut short Nijinsky's career both as performerand choreographer.

Born into a family of ballet dancers, Nijinskylearned to express himself at an early agethrough the medium of dance and by the age offour had made his first public appearance.During this period. Kraepelin was building onthe concepts of Kahlbaum and by 1896 hadformulated his concept of dementia praecox as adiagnostic entity. Based on his observation ofoutcome, he distinguished it from the affectivedisorders and thus established a dichotomy inthe psychoses which has influenced psychiatryto the present day. Kraepelin was a materialistwho believed that mental illness was a disease ofthe brain and that dementia praecox was adisease process for which a cause would eventually be found. This reductionist approach wasbeing challenged by people such as Freud whosesecular approach to problems of the psyche

superseded that of the mentalists in the previouscentury.

Meanwhile. Nijinsky, now eight years old wasenrolled in the Imperial School of Ballet in StPetersburg. His exceptional talent was soonrecognised and compensated for his hyperactivebehaviour, social gaucheness and poor verbalskills in gaining recognition in this prestigiousestablishment. Elsewhere, the world of dancewas being subject to the same influences as art,music and literature. These included a revival ofinterest in antiquity, enthusiasm for primitive artand an increasing preoccupation with the psyche. The effect on Western Art was to change theemphasis from style, decor and narrative toexpressing the subjective experience of theindividual. The renewed interest in the psychewas to have an impact through Freud and Jungon Bleuler's concept of dementia praecox.Although Bleuler accepted that there was anorganic basis to the illness, he believed that therewas a psychological explanation for the moreprominent symptoms. The neologism 'schizophrenia' was coined by him to illustrate hisbroader concept of the illness (Bleuler, 1911).

While Bleuler was attempting to put the psycheback into insanity, Nijinsky was about tograduate from the Imperial School of Ballet. Only18 years old, he already had a role in a new balletcreated especially for him and was in demand asa partner for famous ballerinas. Through hismeeting with Diaghilev, his lover and mentor, hewas exposed to the revolutionary trends inWestern Art and was anxious to incorporatethese trends into dance. As the term schizophrenia began to enter common parlance,Nijinsky. who was later on occasions to embodythe concept, was about to receive both accoladesand disapprobation from Parisian critics andaudiences for his revolutionary choreography.

Paradoxically for someone renowned for hislack of verbal fluency, he was hailed by artists ofhis day for his "extraordinary ability to lend hisbody to the interpretation of the widest possiblerange of feelings." (Rodin, 1912; cited in Nectoux1990). Elsewhere he was described as the authorof a poem in choreography (von Hofmannsthal,1912; cited in Nectoux 1990, pp. 52-53.) This

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begs the question as to what was so uniqueabout Nijinsky's choreography. The process ofrevolutionising dance had already been initiatedby Isadora Duncan and Michel Foklne whoexplored its expressive nature. Nijinsky was todevelop this to its extreme. Jacques Rivière,in1913, (cited in Copeland & Cohen, 1983, pp.115-123) wrote the following on seeing The Ritesof Spring

"With what eloquence he curled himself like a cataround emotions. How he hovered over them closely.How well he knew how to arrange all his limbs in theirimage and make himself their effigy... we are able tocontemplate them before the arrival of language,before they are pressed upon by multitudinous andsubtly varied but loquacious crowds of words... Whatbeauty lies behind this reduced and dislocateddance?"

Nijinsky instinctively believed that movementwas an adequate and effective means of communication. In his ballets, he acknowledged this byrefusing to create an illusion of reality on stage.By relinquishing excessive reliance on stagedecor, mimicry or pantomime and proceeding tobanish all facial expression, he reduced dance toits essential component - movement. In L'ApresMidi d'un Faune, the dancers moved laterallyacross the stage in jerky movements, their bodiesfacing the audience while their feet and headswere turned sideways like figures on an ancientGreek vase (which Nijinsky used for inspiration)suddenly and awkwardly come to life butremaining distant and inaccessible. Nijinsky issaid to have created a fourth wall, taken at thattime for granted in theatre but underdeveloped inthe world of ballet because of its lack of faith initself as a mediator of human experience. Anabstract visual spectacle was presented. Whatwas real was the emotional reaction and interpretation of each individual in the audience. Itwas like someone expecting to attend an exhibition of the old masters suddenly being accostedby the cubist works of Picasso with the exceptionthat the world of art was more prepared for suchinnovation than the world of ballet in 1912.

Nijinsky stripped away the aesthetic in order toexpress the emotional, social and primitivenature of man. It is tempting to speculate thathe compensated for his verbal and socialawkwardness by using dance as his primarymode of expression, so that he was well placed inlater years to develop dance as a sophisticatedindependent form of artistic expression. In doingso, he became an exponent of the expressiontheory of art which views all art as a valid form oflinguistic expression (Collingwood, 1938; cited inCopeland ok Cohen, 1983, pp. 371-376). Communication was extremely important to Nijinsky.He wrote extensively in his diary about hisfeelings, made several abstract drawings and

when unable to perform, demonstrated hisballets to family members.The years following Nijinsky's triumph in Pariswere eventful. There was his sudden marriagewhich precipitated his rupture with Diaghilev,followed by fatherhood, his first encounter withdepression from which he recovered and the FirstWorld War. It was towards the end of the war thatNijinsky's world began to disintegrate. He attempted to convey this in a private performancein St Moritz in 1919 but the form was tooabstract for his audience who may well haveconsidered it further confirmation of his descentinto insanity. Despair, grandiosity, lack ofcomprehension coupled with piercing insightare evident in his diaries. In the early stages ofhis descent into madness, Nijinsky (1973) expressed the fear that he was losing his feelingsand protested against the intellectualisation ofhis mind. Elsewhere he wrote "I want light, thelight of twinkling stars. A twinkling star is life -and a star that does not twinkle is death." Thishas been interpreted as Nijinsky expressing hissense of loss at no longer being able to performon stage (Oswald, 1991) but could also havereflected insight into his loss of emotions andability to feel. He described himself as "sick in mysoul but not in my brain", inadvertently echoingthe debate that divided psychiatrists for decades.For Nijinsky, madness was dehumanising perhaps because it deprived him of his own naturallanguage which had permitted people to penetrate his boorish exterior and see a wealth ofemotion, sensitivity and intelligence. Havingexperienced the alienation of the misunderstoodgenius, Nijinsky was now to experience thedouble alienation of being insane and isolatedfrom his natural and most effective mode of self-expression. His frustration must have beencompounded by his inability to realise the manyballet projects festering in his disorganisedmind.

Nijinsky was to receive several diagnosesthroughout his life. These included dancer'sheart, neurasthenia, dementia praecox, schizophrenia and depression. The confusing nature ofhis symptoms is evident on Bleuler's first meeting with Nijinsky when he pronounced him assuffering from "confused schizophrenia withmild manic symptoms" (Oswald, 1991). No longer allowed to perform phenomenal leaps onstage, Nijinsky was now confined to hurtlinghimself over the Kraepelinian boundaries dividing the psychoses. The incapacitating nature ofhis illness, disorganisation of speech and behaviour, disturbance of affect and catatonic symptoms would have satisfied the criteria of bothBleuler and Kraepelin while his extremes ofmood would have perplexed them, particularlyKraepelin. The presence of first rank symptomswould have been reassuring to Schneider in

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making a diagnosis of schizophrenia althoughthe latter's concept of psychosis as beingqualitatively distinct from the norm and due tosome inherent or congenital defect (Beer. 1995a)would nearly cost Nijinsky his life in Nazioccupied Hungary during the Second WorldWar. Just as his art was susceptible to otherinfluences in society, so was the concept andtreatment of his illness influenced by the prevailing theories and philosophies of the day.

At Bellevue in Switzerland, he was under thecare of Ludwig Binswanger, who influenced byFreud, was interested in psychoanalysis. Therewas considerable interest in Jaspers' phenom-enological approach to psychiatric symptomswith its emphasis on making sense out of thepatient's experience. He also met with Adler, whowas later to write that "Nijinsky's spiritual deathhas aroused the sympathy of a great proportionof the civilised world" (Adler, 1981). Due topractical difficulties, Adler was unable to applyhis methods to Nijinsky's case. At the otherextreme, he underwent 180 treatments of insulinshock treatment under the supervision of itspioneer, Dr Manfred Sakel. This produced atemporary improvement in affective reactivityand was also credited with freeing him fromhallucinations but he suffered linguistic dysfunction which degenerated into word salad.Bleuler's initial impression was that Nijinsky'sprognosis was reasonably good provided that hewas relieved of his family responsibilities andallowed to pursue his artistic instincts, henceBleuler's unwelcome advice on divorce to Nijinsky's wife. The range of treatments reflect thedivergent views of the illness as either psycho-genie or organic in origin. A difficult, sometimesviolent patient, Nijinsky subsequently becamemore manageable and spent the last few years ofhis life after the Second World War with his wifein England.

The renowned and inspirational dancer died inLondon in April 1950, the year The FirstInternational Conference of Psychiatry was heldat which Adolf Meyer (Hafner et al, 1987, pp. 29-38) exclaimed that psychiatrists were in dangerof no longer understanding each other when theyspoke about schizophrenia. Although Nijinsky'slast major public performance was 33 yearsearlier, he remained a legend. His most signifi

cant contribution was his success in realisingNoverre's vision of dance. Meyer's pessimisticappraisal in 1950 would have disheartenedKraepelin who thought he had devised a comprehensible diagnostic language for psychiatry.Nevertheless, his concepts have persisted andare evident in contemporary criteria. Nijinskywas reductionistic in his choreography in orderto lay bare the emotional and instinctual natureof man, to animate the psyche and give it voicethrough the medium of movement. Kraepelinwas also a reductionist but in the oppositedirection in that he saw the soul or psyche ashaving little to do with dementia praecox, aneuropathological disease entity. Their pathsconverged in the psychoses where the psyche ofone endured the torment and was stifled by thepsychoses so eloquently described by the other.

AcknowledgementI thank Dr Roisin Kemp for her helpful comments.

ReferencesADLER, A. (1981) The preface to The Diary of Vaslav

Nyinsky. Archives of General Psychiatry. 38, 834-835.BEERS. M. D. (1995a) The Importance of the social and

intellectual contexts in a discussion of the history of theconcept of psychosis. Psychological Medicine. 25. 317-321.

—¿�(1995b) Psychosis: from mental disorder to diseaseconcept. History of Psychiatry. 6, 177-200.

BLEULER, E. (1911) Dementia Praecox or the Group ofSchizophrenias (trans. J. Zinkin. 1950). New York:International Universities Press.

COPELAND,R. & COHEN.M. (eds) (1983) What is Dance? NewYork: Oxford University Press.

HAFNER, H., GATTAZ,W. F. & JANZARIK.W. (eds) (1987)Search for the Causes of Schizophrenia. New York:Springer-Verlag.

NIJINSKY,V. (1973) The Diary of Vaslav Nijinsky (trans./ed.R. Nijinsky). Berkeley. CA: University of CaliforniaPress.

OSWALD,P. (1991) Vaslav Nyinsky: A Leap into Madness,p. 229. London: Robson Books Ltd.NECTOUX.J. M. (ed.) (1990) Prelude A L'Après-Midi D'unFaune. London: Thames and Hudson.

Josephine Loftus, Specialist Registrar,Community Psychiatric Rehabilitation Team. 50-52 Clifden Road, London, E5 OLJ

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