Theater Can Foster Empathy and Promote a Richer Understanding of Psychosis

The importance of including persons with lived experiences of mental health issues has been called for across research, knowledge production, healthcare training, and clinical practice. A new article highlights how theater promotes empathy for the lived experiences of psychosis, which can facilitate social change.

The article, published in the Psychiatric Rehabilitation Journal, describes how theater can provide deeper insights into the what-its-likeness of psychosis for those who do not have those experiences and provide a voice for those who do, which in turn can foster greater understanding and connection.

Psychotic experiences can include hearing voices others do not and unusual beliefs and perceptions. Lack of understanding and relatability for individuals who have psychotic experiences contributes to social alienation, exclusion, and stigma. Additionally, traditional treatments for psychosis tend to focus on the individual and their “symptoms” to the neglect of the person’s social environment.

The authors, led by Yulia Landa of the Department of Psychiatry at Mount Sinai, write:

Landa and colleagues present a play titled “Voices,” written, directed, and performed by a person with lived experiences of voice-hearing. The play was written throughout several therapy sessions, with the intent for the person to explore and gain control over their experiences of voice-hearing, in addition to humanizing and reducing the stigma associated with psychosis. It was performed at the 2021 Conference and Annual Meeting of the International Society for Psychological and Social Approaches to Psychosis.

The authors draw from psychological literature that focuses on the social, art, and narratives to describe how art can serve as an outlet to empower persons with lived experiences of psychosis and lead to social connection and understanding from the larger population.

Referencing the work of psychological thinkers like Vygotsky and Semenov, the authors describe how art provides access to emotional experiences and themes that can’t otherwise be captured or expressed in daily life. In other words, art mediates between the inner world of the artist and the external world and provides a safe outlet for building connections with self and others.

Illuminating the lived experience of psychosis through a play allows for the exploration of themes and prompts considerations that might not otherwise be accessed through clinical descriptions of psychotic experiences.

For example, Landa and colleagues describe how “Voices:”

Creative channels are not only beneficial in facilitating understanding and empathy for experiences that might otherwise be difficult for the general population to grasp but also in increasing their willingness to support individuals experiencing bipolar disorder or schizophrenia. These benefits have been found across service users, healthcare providers, adolescents, young adults, and individuals with ethnic minority backgrounds.

Landa and colleagues elaborate on how the use of theater and the arts leads to the reduction of stigma and increased openness to engaging with those experiencing psychosis: “The stigma reduction mechanism in many of these studies is “contact”—a person with lived mental health experience (or someone acting as one) sharing their story. Contact-based approaches have the strongest impact on public mental health stigma, likely through processes of increased empathy and decreased fear.”

In addition to providing insight and understanding for those not experiencing psychosis, the use of art is also helpful to the person experiencing psychosis themselves to cultivate self-empathy, build connection, reduce feelings of alienation, improve self-advocacy, and communicate their experiences.

Participation in theater, improvisation, and acting has also been shown to improve overall functioning and increase a sense of hopefulness about recovery for individuals experiencing psychosis. The authors examine how both acting and roleplays provide space for individuals to practice challenging conversations, including with the voices themselves, which can lead to insight, a sense of normalization, liberation, and empowerment.

The writer and director of the play describes her own experiences of roleplaying in therapy:

While psychodrama and theater-related techniques, like roleplaying, have a long history of being used in therapy, they often focus on the individual or family. What makes this approach unique is its focus on the community at large and, as a result, its ability to create and cultivate shared communal experiences and social change.

Although this approach shows promise, there are some limitations. For example, Landa and colleagues warn that some individuals may struggle to create narrative accounts of their experiences. They suggest that Narrative Enhancement and Cognitive Therapy could be helpful in these cases, as they aim to address internalized stigma and use narrative therapy to help persons with serious mental illness create narratives of their life stories.

Moreover, theatrical production is not guaranteed to affect every audience member. Personal characteristics, including the spectator’s life experiences and cultural backgrounds, influence how much they can identify with the story’s protagonist. As such, creating relatable protagonists is a crucial piece of developing theater that will have a lasting impact on audience members.

Listening to the perspectives of individuals with lived experiences of psychosis has long been advocated for across psychological literature, as noted at the beginning of this article. Collaborating with persons with firsthand experiences of psychosis and other mental health issues opens up possibilities for new understandings and treatments geared toward what service users want and need instead of being told what they need by mental health professionals.

One such study found that most individuals participating in a therapy trial wanted to focus on other issues in therapy, not on reducing their psychotic symptoms, which is often the approach in traditional treatment.

Others have created projects led entirely by persons with lived experience, such as Psychosis Outside the Box, a user-led project that offers firsthand narratives of the range of experiences that fall under the umbrella of “psychosis.” As stigma for psychosis continues to increase, it is clear that the focus on biological or brain-based explanations of psychosis is not effective in cultivating understanding and empathy.

Service-user-led and collaborative approaches to research and practice, including using creative means like theater, offer alternative paths forward that lead to greater understanding and empathy.

 

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Landa, Y., Levitt, J., Jespersen, R., Jacobs, M. A., DeLuca, J. S., & Yanos, P. T. (2023). Who Is afraid of Hermy and Jimmy? Relating to and normalizing psychosis through theater. Psychiatric Rehabilitation Journal. Advance online publication. https://dx.doi.org/10.1037/prj0000572 (Link)